VA Disability Benefits for Hernia

CCK Law: Our Vital Role in Veterans Law

What is a Hernia?

A hernia occurs when an organ pushes through an opening in the muscle or tissue that holds it in place.  Many hernias occur in the abdomen between your chest and hips, but they can also appear in the upper thigh and groin areas.  One of the most common types of hernia is an inguinal hernia, which occurs when tissue (e.g., part of the intestine) protrudes through a weak spot in the abdominal muscles.  Signs and symptoms of a hernia include the following:

• A bulge or lump in the affected area that is more noticeable when upright
• A burning or aching sensation at the bulge
• Pain or discomfort when bending over, coughing, or lifting
• A heavy or dragging sensation
• Weakness or pressure
• Occasionally, swelling around the bulge

Hernias are typically due to a combination of muscle weakness and strain.  Depending on the cause, hernias can develop quickly or over a long period of time.  Common causes of muscle weakness or strain that can lead to a hernia include:

• A congenital condition that occurs during development in the womb and is present from birth
• Aging
• Damage from an injury or surgery
• Chronic coughing or chronic obstructive pulmonary disorder (COPD)
• Strenuous exercise or lifting heavy weights
• Pregnancy
• Constipation
• Being overweight or obese

Importantly, many veterans suffer from hernias that are related to previous injuries or the strenuous nature of their service.  If a veteran can prove to VA that their hernia is due to their time in service, they may be eligible for VA disability benefits.

VA Service Connection for Hernias

In order to receive VA disability compensation for hernias, veterans must establish service connection.  The most common type of service connection is direct service connection, which is made up of three elements: (1) a current diagnosis of a hernia; (2) an in-service event, injury, or illness; and (3) a medical nexus linking the current, diagnosed hernia to the in-service event, injury, or illness.  To establish direct service connection, veterans should consider submitting argument and evidence in support of their hernia claims.  Examples of evidence may include service and medical personnel records, lay statements, and private doctor’s opinions.

If a veteran believes their hernia was caused or aggravated by another service-connected condition, they may be eligible for secondary service connection for their hernia.  In this case, veterans will have to demonstrate that their primary service-connected condition is medically linked to their hernia.  The above-mentioned types of evidence may be beneficial in claims for secondary service connection as well.

How VA Rates Hernias

The most common types of hernias involve the abdominal cavity and are rated under other codes according to the Digestive System rating schedule. These types of hernias include inguinal, femoral, ventral, and hiatal.

Hernias, with the exception of hiatal hernias, are rated under 38 CFR § 4.114, Schedule of Ratings – Digestive System, Diagnostic Code 7338. The rating criteria for this code are as follows:

• 100 percent – “Irreparable hernia (new or recurrent) present for 12 months or more; with both of the following present for 12 months or more: 1. Size equal to 15 cm or greater in one dimension; and 2. Pain when performing at least three of the following activities:
  • bending over
  • activities of daily living (ADLs)
  • walking
  • climbing stairs”

• 60 percent – “Irreparable hernia (new or recurrent) present for 12 months or more; with both of the following present for 12 months or more: 1. Size equal to 15 cm or greater in one dimension; and 2. Pain when performing two of the following activities:
  • bending over
  • activities of daily living (ADLs)
  • walking
  • climbing stairs”
• 30 percent – “Irreparable hernia (new or recurrent) present for 12 months or more; with both of the following present for 12 months or more: 1. Size equal to 3 cm or greater but less than 15 cm in one dimension; and 2. Pain when performing at least two of the following activities:
  • bending over,
  • activities of daily living (ADLs)
  • walking
  • climbing stairs”
• 20 percent – “Irreparable hernia (new or recurrent) present for 12 months or more; with both of the following present for 12 months or more: 1. Size equal to 3 cm or greater but less than 15 cm in one dimension; and 2. Pain when performing one of the following activities:
  • bending over,
  • activities of daily living (ADLs)
  • walking
  • climbing stairs”
• 10 percent – “Irreparable hernia (new or recurrent) present for 12 months or more; with hernia size smaller than 3 cm”
• 0 percent – “Asymptomatic hernia; present and repairable, or repaired”