Hernias C&P Exam Prep

Hernia Size Measurement

What it measures: The largest single dimension of the hernia defect or bulge in centimeters, which is a direct rating threshold under DC 7338.

What to expect: The examiner will physically palpate and visually inspect the hernia, possibly using a measuring tape or ruler. You may be asked to stand or perform a Valsalva maneuver (bear down) to maximize the visible and palpable extent of the hernia.

Pain considerations: Pain during palpation of the hernia should be reported immediately and clearly. Inform the examiner which movements cause the hernia to become more pronounced or painful. Do not minimize discomfort during the examination.

Reducibility Assessment

What it measures: Whether the hernia contents can be manually pushed back through the defect (reducible) or cannot be reduced (irreducible/incarcerated). Irreparability is a key factor in the highest rating tiers.

What to expect: The examiner may attempt to gently reduce the hernia manually. You may be asked to lie down and relax your abdominal muscles. The examiner will note whether the hernia reduces spontaneously when supine, requires manual reduction, or is irreducible.

Pain considerations: Report whether the hernia causes sharp, burning, or pressure-type pain when it bulges out, and whether that pain is constant or episodic.

Functional Activity Pain Assessment

What it measures: Whether you experience pain in at least three of the four qualifying activities: (1) bending over, (2) activities of daily living, (3) walking, and (4) climbing stairs. This is a direct rating threshold under DC 7338.

What to expect: The examiner will ask you directly about pain with each of these four activities. You may be asked to demonstrate some of these activities in the exam room. The examiner will check specific DBQ boxes for each activity where pain is reported.

Pain considerations: Rate and describe pain at its worst during these activities, not an average. Per M21-1 guidance, you are entitled to have your condition evaluated at its worst presentation.

100%

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, and climbing stairs.

From 38 CFR: Under DC 7338: A veteran with a massive incisional hernia following abdominal surgery that is deemed irreparable due to multiple failed repairs, measuring 18 cm in diameter, causing pain when bending over to dress, walking more than one block, and ascending stairs daily for over 12 months would meet the 100% criteria.

60%

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 three of the four qualifying activities (bending over, ADLs, walking, climbing stairs).

From 38 CFR: A veteran with an irreparable bilateral inguinal hernia measuring 7 cm on the right side, causing daily pain when bending to tie shoes, walking to the car, climbing steps into the home, and performing hygiene tasks for over a year would support a 60% rating.

30%

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 four qualifying activities.

From 38 CFR: A veteran with an irreparable incisional hernia measuring 5 cm, causing pain with walking and bending over but not with ADLs or stair climbing, present for over a year, would support a 30% rating.

20%

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 one of the four qualifying activities. OR: Irreparable hernia with size smaller than 3 cm with pain in at least three of the four qualifying activities.

From 38 CFR: A veteran with a 4 cm irreparable umbilical hernia causing pain only when climbing stairs, present for over 12 months, may qualify for a 20% rating.

10%

Irreparable hernia present for 12 months or more; size smaller than 3 cm in one dimension; with pain when performing at least two of the four qualifying activities for 12 months or more.

From 38 CFR: A veteran with a small 2 cm irreparable femoral hernia causing pain when walking and bending over for the past year would support a 10% rating.

0%

Hernia present but does not meet any of the above criteria. May include reparable hernias, hernias without documented pain in qualifying activities, or hernias present less than 12 months. A 0% noncompensable rating still establishes service connection.

From 38 CFR: A veteran with a small reparable inguinal hernia that does not cause pain with any qualifying activity. Service connection may still be warranted even at 0%.

Pain with Bending Over

How to describe it: Describe the exact character of pain when you bend forward - whether it is sharp, stabbing, aching, or a pressure sensation. Note the location (groin, abdomen, umbilical area), radiation pattern, and how quickly pain begins. Specify whether the pain prevents you from completing the bending motion fully or causes you to stop the activity.

Example: On my worst days, when I bend over to pick up something from the floor, I feel an immediate sharp stabbing pain in my right groin that shoots down toward my thigh. The hernia bulges out significantly and I have to immediately stand upright. I cannot complete the bending motion and sometimes have to kneel instead, which is also painful.

Examiner listens for: The examiner is checking a specific DBQ box for 'bending over' as one of the four qualifying pain activities under DC 7338. They need to hear that pain occurs during this specific activity and that it has been present for at least 12 months.

Avoid: Do not say 'it is a little uncomfortable when I bend' or 'sometimes I feel some pressure.' Be specific: 'I experience pain when bending over that forces me to modify or stop the activity.'

Pain with Activities of Daily Living (ADLs)

How to describe it: Under DC 7338, ADLs include bathing, dressing, hygiene, and transfers. You only need to demonstrate pain in ONE of these. Describe specifically which ADL causes pain - for example, bending to put on socks and shoes, reaching arms overhead to put on a shirt, stepping in and out of the bathtub, or rising from a seated position.

Example: On a bad day, I cannot step over the bathtub ledge without pain because it requires lifting my leg high and engaging my core. Getting dressed in the morning - putting on pants and socks - causes a pulling, aching pain in my lower abdomen every single day. I have had to modify how I dress and now sit on a chair to put on my pants.

Examiner listens for: The examiner will mark the ADL checkbox on the DBQ. They need to hear that at least one specific daily living activity causes hernia-related pain and that this has been ongoing for 12 or more months.

Avoid: Do not broadly say 'I have some trouble with daily activities.' Be specific: name the exact activity, describe the pain it causes, and state how long this has been a problem.

Pain with Walking

How to describe it: Describe how far you can walk before hernia pain begins, how the pain feels (groin pull, abdominal pressure, sharp ache), and what you have to do when it starts (stop, sit, apply manual pressure to the hernia). Note whether the hernia protrudes more with walking and whether prolonged walking causes the hernia to become irreducible.

Example: On my worst days, I cannot walk more than half a block before the hernia bulges out and I feel intense pressure and aching pain in my groin. I have to stop, press the hernia back in manually, and rest before I can continue. I avoid walking long distances and no longer walk around the block or go to the grocery store without a cart to lean on.

Examiner listens for: The examiner will check the 'walking' box on the DBQ. They need clear evidence that walking - a routine daily activity - causes hernia pain and has done so consistently for at least 12 months.

Avoid: Do not say 'I can walk fine, I just don't walk far.' Describe the actual limitation: the distance you can walk, what happens when you reach that limit, and how this compares to before the hernia.

Pain with Climbing Stairs

How to describe it: Describe whether climbing stairs causes immediate pain or pressure, whether you must use the handrail for support due to hernia pain, how many stairs you can manage before pain begins, and whether you avoid stairs entirely. Note whether descending stairs also causes pain.

Example: On my worst days, I cannot climb the 12 steps in my home without stopping midway because of sharp groin pain and a heavy bulging sensation from the hernia. I grip the railing tightly and go slowly, one step at a time. Afterward I feel a dull ache in the area for hours. I have considered moving to a single-floor home because of this.

Examiner listens for: The examiner will mark the 'climbing stairs' checkbox. They need to hear that stair climbing specifically causes hernia pain, and that this limitation has been present for 12 or more months.

Avoid: Do not say 'stairs are a little tough.' Say: 'Climbing stairs causes pain in my hernia that makes me stop or significantly slow down, and this has been the case for over a year.'

Hernia Duration and Chronicity

How to describe it: The 12-month duration requirement is critical across all rating tiers under DC 7338. Be prepared to state clearly when you first noticed the hernia, when it was first diagnosed, and whether it has been continuously present or has recurred after surgery. Reference service records, deployment timelines, and medical records to anchor the onset date.

Example: This hernia was first noticed during my deployment in [location] when I lifted heavy equipment and felt a sudden pop and pain in my groin. It was documented in my sick call records in [year]. I have had this hernia continuously since then - more than [X] years - and it has been present every day without remission.

Examiner listens for: The examiner will note the date of diagnosis and assess whether the 12-month criterion is met. They need a clear, consistent history tying the hernia to a specific onset date and confirming continuous presence.

Avoid: Do not be vague about timing. Avoid saying 'I've had this for a while.' State the specific year or period of onset and connect it clearly to your military service or a service-connected event.

Irreparability

How to describe it: If a surgeon or physician has told you the hernia cannot be repaired - due to prior failed repairs, your medical comorbidities making surgery too risky, or the anatomy of the defect - state this explicitly and bring documentation. Describe any prior repair attempts, recurrences, and what the treating surgeon told you about future surgical options.

Example: I had hernia repair surgery in [year] but the hernia recurred within 18 months. My surgeon evaluated me again in [year] and told me that a second repair was not recommended due to the amount of scar tissue and the risk of bowel injury. He documented in my chart that the hernia is considered irreparable. I have that note with me today.

Examiner listens for: The examiner will look for documentation from a medical professional stating the hernia is irreparable and explaining why. This is a required element for the highest rating tiers. The DBQ has a specific field (field 201) for the examiner to document this explanation.

Avoid: Do not assume the examiner knows your hernia is irreparable. State it explicitly: 'My surgeon told me this hernia cannot be repaired and documented this in my medical records, which I have brought with me today.'