Ventral hernia question

[lotzaspotz]

I have a question, if anyone here can assist. Have any of you been awarded a compensable rating (at least 20%) for a ventral (abdominal) hernia, even though you were never formally prescribed a belt/truss?

The reason I'm asking is the VA is interpreting DC 7339 (ventral hernia) at the 20% disability level as requiring a prescription for a belt. However, the rating criteria doesn't state that a prescribed belt is required - what it does say is that the need for a belt is "indicated." What is the legal definition of "indicated?" Usually, when the VA requires something of this nature, it clearly says so. Also, I found a Board appeal where the veteran was awarded 20%, but clearly stated during a Board hearing that he didn't wear a belt. His appeal for an increase to 40% was denied, but the Board let him keep his 20%. This rating hadn't reached the 20 year mark, either.

Thanks for any additional information you may be able to give.

[NoTheEnemy]

On 1/22/2017 at 11:57 PM, lotzaspotz said:

I have a question, if anyone here can assist. Have any of you been awarded a compensable rating (at least 20%) for a ventral (abdominal) hernia, even though you were never formally prescribed a belt/truss?

The reason I'm asking is the VA is interpreting DC 7339 (ventral hernia) at the 20% disability level as requiring a prescription for a belt. However, the rating criteria doesn't state that a prescribed belt is required - what it does say is that the need for a belt is "indicated." What is the legal definition of "indicated?" Usually, when the VA requires something of this nature, it clearly says so. Also, I found a Board appeal where the veteran was awarded 20%, but clearly stated during a Board hearing that he didn't wear a belt. His appeal for an increase to 40% was denied, but the Board let him keep his 20%. This rating hadn't reached the 20 year mark, either.

Thanks for any additional information you may be able to give.

I know that to get 50% for sleep apnea with c-pap, we don't have to have evidence of a prescribed c-pap machine The exam only has to state that a c-pap would benefit the veteran (paraphrasing). So, the same could be true for the language for 7339. I'll ask around in the morning at work, do some research and get a definitive answer for you

[NoTheEnemy]

On 1/22/2017 at 11:57 PM, lotzaspotz said:

I have a question, if anyone here can assist. Have any of you been awarded a compensable rating (at least 20%) for a ventral (abdominal) hernia, even though you were never formally prescribed a belt/truss?

The reason I'm asking is the VA is interpreting DC 7339 (ventral hernia) at the 20% disability level as requiring a prescription for a belt. However, the rating criteria doesn't state that a prescribed belt is required - what it does say is that the need for a belt is "indicated." What is the legal definition of "indicated?" Usually, when the VA requires something of this nature, it clearly says so. Also, I found a Board appeal where the veteran was awarded 20%, but clearly stated during a Board hearing that he didn't wear a belt. His appeal for an increase to 40% was denied, but the Board let him keep his 20%. This rating hadn't reached the 20 year mark, either.

Thanks for any additional information you may be able to give.

from 38 CFR 4.114 Schedule of ratings -Digestive system

20% Small, not well supported by belt under ordinary conditions, OR healed ventral hernia or post-operative wounds with weakening of abdominal wall AND indication for a supporting belt. 

0% Wounds, postoperative, healed, no disability, belt not indicated

My interpretation is that the belt is required because if you look at the 0% criteria, it shows that if a belt is not indicated then it only warrants a zero. 

I would ask myself..."Is a belt indicated? If yes, do either one of the criteria for the next higher percentage apply? If no, then the condition is rated at 0%

Also, the supporting belt alone would not warrant a 20% evaluation. Evidence has to show a healed ventral hernia or post-operative wounds with weakening of abdominal wall as well. 

The veteran in that hearing could have been awarded the benefit based on "not well supported by belt under ordinary conditions" and therefore didn't wear one because it didn't offer support anyway. 

I hope this helps. 

[lotzaspotz]

Thank you!

 

[NoTheEnemy]

You're very welcome. I'm happy to assist.