question on C&P result for hernia claim

[jjf]

Hello, first post here.  I'm 30% since '98 for four unrelated 10% issues but am trying to service connect a recurring hernia issue I feel started AD.  I had umbilical hernia corrected as an infant, and listed that on my military entrance exams and it was never an issue. I did almost 12yrs active duty, the last few years I had pains in right testical when lifting heavy objects and a few times in my SMR it's listed as 'possible abdominal hernia' or 'possible umbilical hernia' and the pain and bulge in area listed is even on my exit exam 1998 and original VA exam that year.

After getting out the pain grew, bulge grew more towards inguinal area, and finally I saw a private doc and he stated I had inguinal hernia. Since 2012 I've had 3 private surgeries, and looks like I have a 4th hernia in same area.

I filed a claim 2014 for inguinal hernia, finally had a C&P for it a few months ago, and was just denied.  Just got a copy of the private contracted Physican's Assistant's C&P report that did my exam and this is exactly as he stated:

"The veteran notes that during active service he often complained of right scrotal pain with a bulge but no treatment was done. Symptoms started around 1996 and although he was seen he was never treated.
The veteran is claiming service connection for inguinal hernia condition. He is not previously rated for this condition. According to Veteran's provided entrance exam it was docuented that the veteran had an issue with his abdomen and viscera. This is an indication that the veteran may have had a hernia prior to military service. I have reviewed all the above coming to the conclusion the Veteran's hernia is not due to military service"

I have a few problems with that statement above, just looking for some outside feedback, thank you!

[jjf]

On ‎6‎/‎21‎/‎2016 at 11:31 AM, jjf said:

Hello, first post here.  I'm 30% since '98 for four unrelated 10% issues but am trying to service connect a recurring hernia issue I feel started AD.  I had umbilical hernia corrected as an infant, and listed that on my military entrance exams and it was never an issue. I did almost 12yrs active duty, the last few years I had pains in right testical when lifting heavy objects and a few times in my SMR it's listed as 'possible abdominal hernia' or 'possible umbilical hernia' and the pain and bulge in area listed is even on my exit exam 1998 and original VA exam that year.

After getting out the pain grew, bulge grew more towards inguinal area, and finally I saw a private doc and he stated I had inguinal hernia. Since 2012 I've had 3 private surgeries, and looks like I have a 4th hernia in same area.

I filed a claim 2014 for inguinal hernia, finally had a C&P for it a few months ago, and was just denied.  Just got a copy of the private contracted Physican's Assistant's C&P report that did my exam and this is exactly as he stated:

"The veteran notes that during active service he often complained of right scrotal pain with a bulge but no treatment was done. Symptoms started around 1996 and although he was seen he was never treated.
The veteran is claiming service connection for inguinal hernia condition. He is not previously rated for this condition. According to Veteran's provided entrance exam it was docuented that the veteran had an issue with his abdomen and viscera. This is an indication that the veteran may have had a hernia prior to military service. I have reviewed all the above coming to the conclusion the Veteran's hernia is not due to military service"

I have a few problems with that statement above, just looking for some outside feedback, thank you!

I'm not sure why the PA that did the c&p/wrote the report stated that on my entrance exam it was documented that I had 'an issue with his abdomen and viscera', all it states on any of my records is that I had surgery at 1yr old for umbilical hernia, and never had any further problems with it. 

My main issue is the report stated that I 'may have had a hernia prior to military service'. If that is the case how did I pass my enlistment exam (twice 1985 then 1990, I had a year broken service after first enlistment) with no mention of a possible current hernia? Nothing noted in my records for 9yrs until I started having testicle pain and groinal area bulge a few years before I got out? And if that's the case wouldn't his conclusion be considered aggravation of a pre existing condition?

But even that's a moot point really, I had umbilical hernia as infant and what I ultimately ended up with was inguinal hernia, I'm sure to a surgeon that's the difference of a wrist and elbow injury.

Edited June 23, 2016 by jjf

[broncovet]

Ok.   This exam is a deal breaker.  You need to rebut it.  YOu can/should order your cfile and see if there is a doctor report with something more favorable, such as its at least as likely as not your hernia was aggravated in service. 

Remember the CAluza triangle:

1.  current diagnosis

2.  DOcumetation of in serive event or AGGRAVATION.  You probably need to focus on aggravation, since it was documented prior to service.  

3.  Read all you can about case law for agravation/and or try to get an IMO or IME for aggravation.  As it stands, your hernia  claim has very little  chance in suceeding absent a more favorable medical opinion.  

Edited June 23, 2016 by broncovet

[broncovet]

Remember, too, the VA loves "doctor shopping" to find an excuse to deny.  If you already had a valid nexus statement, the VA just got their excuse to deny.  

[flores97]

jjf, I agree with broncovet, you are entitled to compensation EVEN for preexisting conditions(I'm not saying that it was preexisting, but), if the condition is worsened or aggravated by military service. There is no way that a hernia would not be aggravated by military service, as we had to lift heavy loads on a regular basis and participate in physical fitness training. The easiest way to get service connected for this, as bronco stated, try to get a doctors opinion on whether military service aggravated your hernia. You don't have to use a VA Doc, you can use your private doctor, it would be good to use a physician that has operated on you for the hernia, and whose care you were under the longest IF possible. I wish you the best of luck!!

[jjf]

thank you both for taking the time to reply and your thoughts, much appreciated!

It's disheartening as I've had two yearly physicals with two different VA docs at my local clinic whom both during my visit I showed pages from my service records stating the possible hernia diagnosis while I was active duty and both thought my recurring hernias should be service connected, yet the private contracted outside physician's assistant that did the official c&p thought otherwise.

I did request my c-file and will work on getting my personal private insurance family doc (whom I've seen since I got out in 98) and also my surgeon that did my 2nd and 3rd surgery to put something in writing linking my military service/diagnosis to the problems I've had with this hernia.