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C&P Exam Prep: Hernias
DBQ Overview
Interview + Physical- Form Name
- hernias-including-abdominal-inguinal-and-femoral-hernias
- Form Code
- hernias-including-abdominal-inguinal-and-femoral-hernias
- Page Count
- 8
- Examiner Type
- Physician
- Estimated Duration
- 30 minutes
- Exam Format
- Interview + Physical
What to Expect During Your Exam
Exam Overview
To document the current severity, size, reducibility, surgical history, and functional impact of your hernia in order to assign an accurate disability rating under 38 CFR 4.114, DC 7338.
What the examiner evaluates:
- Type of hernia (inguinal, femoral, umbilical, ventral, incisional, or other)
- Whether the hernia is repaired or unrepaired (reducible vs. irreparable)
- Physical size of the hernia measured in centimeters in at least one dimension
- Whether pain occurs during specific activities: bending over, activities of daily living (ADLs), walking, and climbing stairs
- Duration of the hernia and any recurrence after surgical repair
- Complete surgical history including dates, types of procedures, and outcomes
- Functional limitations caused by the hernia in daily life and employment
- Any complications such as incarceration, strangulation, or obstruction
- Current medications prescribed for the condition
- Whether the hernia has been present or recurrent for 12 months or more
Exam will include a physical examination of the hernia site. You may be asked to stand, cough, bear down (Valsalva maneuver), or perform movements to demonstrate the hernia. Wear comfortable, loose-fitting clothing that allows easy access to the abdominal/groin region. The examiner will likely palpate the hernia site and attempt to assess reducibility and size.
Typical duration: 30 minutes
Hernia Size Measurement
The physical dimensions of the hernia defect or protrusion, measured in centimeters, in at least one dimension. This is a critical threshold measurement directly tied to rating percentages under DC 7338.
What to expect:
The examiner will palpate the hernia and attempt to measure its diameter or longest dimension in centimeters. This may be done with calipers or by estimation. You may be asked to stand and bear down (Valsalva maneuver) to maximize the visible protrusion so the examiner can obtain the most accurate measurement.
Key thresholds:
- Less than 3 cm in any dimension — Corresponds to lower rating tiers; may support 0% to 10% depending on other factors
- 3 cm or greater but less than 15 cm in one dimension — Intermediate rating tiers (20-30%); combined with pain criteria determines level
- 15 cm or greater in one dimension — Required for the highest rating tiers (60-100%) when combined with pain and irreparability criteria
Tips:
- If your hernia is larger when you have been on your feet all day, mention this to the examiner and ask to be measured after standing or bearing down.
- If you have prior imaging or clinical notes documenting a larger size, bring those records as the examiner must document the date and source of size measurements.
- Hernias can reduce when lying down; insist on being examined standing and while performing the Valsalva maneuver for the most accurate representation.
- If prior records show a different (possibly larger) size, specifically reference those records and ask the examiner to note them.
Pain considerations: Pain associated with hernia is not separately rated but is a required criterion at higher rating levels. Specifically, the examiner assesses whether you experience pain during bending over, ADLs, walking, and climbing stairs. The number of these activities during which you experience pain directly determines your rating tier. Be accurate and specific about pain with each of these four activities.
Reducibility Assessment (Repaired vs. Irreparable)
Whether the hernia can be manually reduced (pushed back into the abdominal cavity) or is irreparable/irreducible. Irreparability is a required finding for ratings of 30% and above under DC 7338.
What to expect:
The examiner will attempt to manually reduce the hernia by gentle pressure. They will also review surgical history to determine if a repair was attempted and failed (recurrent hernia). You will be asked about any prior surgeries and their outcomes.
Key thresholds:
- Reducible hernia — Limits rating to 0% or 10% tiers regardless of size
- Irreparable hernia (not surgically correctable or recurrent after surgery) present for 12 months or more — Required criterion to access 30%, 60%, or 100% rating tiers
Tips:
- Clearly communicate to the examiner if prior surgical repair has failed and the hernia has returned, as this constitutes a 'recurrent' hernia qualifying as irreparable for rating purposes.
- If surgery has been recommended but you are not a surgical candidate due to other medical conditions, ensure the examiner documents this and explain why surgery is contraindicated.
- Have documentation ready showing dates of any prior hernia repair surgeries and the recurrence.
- If your hernia cannot be reduced even when lying down, clearly communicate this.
Pain considerations: Irreparability combined with size and the number of painful activities is the backbone of the rating scale. Accurately convey whether pain or surgical complications prevent reduction.
Functional Activity Pain Assessment
Whether you experience pain specifically during four defined activities: (1) bending over, (2) activities of daily living such as bathing, dressing, hygiene, and transfers, (3) walking, and (4) climbing stairs. The number of activities with pain drives rating percentage under DC 7338.
What to expect:
The examiner will ask whether you have pain during each of these four specific activities. They may observe your gait or posture. Be prepared to describe pain for each activity separately and specifically.
Key thresholds:
- Pain with at least 1 of the 4 activities — Contributes to 30% tier when combined with irreparability and size 3-15 cm
- Pain with at least 2 of the 4 activities — Contributes to 60% tier when combined with irreparability and size 3-15 cm
- Pain with at least 3 of the 4 activities — Required for 100% tier when combined with irreparability and size 15 cm or greater; also required for 60% at that size
Tips:
- Think through each of the four activities separately before your exam and be ready to describe pain for each one individually.
- Do not bundle all activities together - the examiner needs to check each activity box on the DBQ form separately.
- Per M21-1 guidance, report your symptoms as they exist on your worst days, not only on good days.
- Note (2) under DC 7338 clarifies that any ONE of the following ADLs is sufficient: bathing, dressing, hygiene, and/or transfers. You do not need pain with all ADLs, just at least one.
- Describe not just whether you have pain but also the character, severity (0-10 scale), and how it limits the activity.
Pain considerations: Pain is the primary functional driver of rating under DC 7338. Accurately describe the onset of pain, its severity, whether it causes you to stop the activity, and how long the pain lasts after the activity.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 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 four activities: bending over, ADLs, walking, and climbing stairs. |
CFR: A large irreparable ventral hernia measuring 18 cm, with documented pain during bending, walking, and climbing stairs for over 12 months. |
| 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 15 cm or greater in one dimension; AND (2) Pain when performing at least TWO of the four activities. OR: Irreparable hernia present 12+ months; size 3 cm or greater but less than 15 cm in one dimension; AND pain with at least THREE of the four activities. |
CFR: An irreparable incisional hernia measuring 16 cm with pain during bending and walking for over 12 months, or a 7 cm irreparable inguinal hernia with pain during bending, ADLs, and climbing stairs. |
| 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 activities. |
CFR: An irreparable inguinal hernia measuring 5 cm with pain during bending and walking for over 12 months. |
| 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 activities. |
CFR: An irreparable femoral hernia measuring 4 cm with pain only during climbing stairs for over 12 months. |
| 10% | Irreparable hernia (new or recurrent) present for 12 months or more; size smaller than 3 cm; with pain when performing at least ONE of the four activities. OR: Repaired hernia with size smaller than 3 cm and pain with at least one activity. |
CFR: A small 2 cm irreparable inguinal hernia with pain only during bending over. |
| 0% | Hernia is repaired with no recurrence, no symptoms, or is a small reducible hernia with no pain during any of the four defined activities. |
CFR: A successfully repaired inguinal hernia with no recurrence and no reported pain. |
100% Irreparable hernia (new or recurrent) present for 12 months ...
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 four activities: bending over, ADLs, walking, and climbing stairs.
Key Symptoms
- Irreparable or recurrent hernia documented for 12+ months
- Hernia measures 15 cm or greater in one dimension
- Pain with bending over
- Pain with activities of daily living (bathing, dressing, hygiene, or transfers)
- Pain with walking
- Pain with climbing stairs (at least 3 of these 4 activities must be present)
CFR: A large irreparable ventral hernia measuring 18 cm, with documented pain during bending, walking, and climbing stairs for over 12 months.
60% Irreparable hernia (new or recurrent) present for 12 months ...
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 TWO of the four activities. OR: Irreparable hernia present 12+ months; size 3 cm or greater but less than 15 cm in one dimension; AND pain with at least THREE of the four activities.
Key Symptoms
- Irreparable or recurrent hernia for 12+ months
- Size 15 cm or greater with pain in 2 of 4 activities, OR size 3-15 cm with pain in 3 of 4 activities
- Pain with multiple defined activities reducing quality of life and function
CFR: An irreparable incisional hernia measuring 16 cm with pain during bending and walking for over 12 months, or a 7 cm irreparable inguinal hernia with pain during bending, ADLs, and climbing stairs.
30% Irreparable hernia (new or recurrent) present for 12 months ...
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 activities.
Key Symptoms
- Irreparable or recurrent hernia for 12+ months
- Hernia size 3 cm or greater but less than 15 cm
- Pain with at least 2 of 4 activities: bending, ADLs, walking, climbing stairs
CFR: An irreparable inguinal hernia measuring 5 cm with pain during bending and walking for over 12 months.
20% Irreparable hernia (new or recurrent) present for 12 months ...
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 activities.
Key Symptoms
- Irreparable or recurrent hernia for 12+ months
- Size 3 cm or greater but less than 15 cm
- Pain with at least 1 of 4 defined activities
CFR: An irreparable femoral hernia measuring 4 cm with pain only during climbing stairs for over 12 months.
10% Irreparable hernia (new or recurrent) present for 12 months ...
Irreparable hernia (new or recurrent) present for 12 months or more; size smaller than 3 cm; with pain when performing at least ONE of the four activities. OR: Repaired hernia with size smaller than 3 cm and pain with at least one activity.
Key Symptoms
- Small hernia less than 3 cm
- At least some pain with one defined activity
- Hernia present or recurrent for 12+ months
CFR: A small 2 cm irreparable inguinal hernia with pain only during bending over.
0% Hernia is repaired with no recurrence, no symptoms, or is a ...
Hernia is repaired with no recurrence, no symptoms, or is a small reducible hernia with no pain during any of the four defined activities.
Key Symptoms
- Fully repaired hernia with no recurrence
- No pain during bending, ADLs, walking, or climbing stairs
- Hernia completely reducible with no functional limitation
CFR: A successfully repaired inguinal hernia with no recurrence and no reported pain.
How to Describe Your Symptoms
Pain with Bending Over
How to describe:
Describe the exact location of pain (groin, lower abdomen, surgical scar site), the type of pain (sharp, burning, aching, pressure, pulling), the severity on a 0-10 scale, and what happens when you try to bend - do you stop midway, brace yourself, or avoid bending entirely? Describe how long the pain lasts after bending.
Worst-day example:
“On my worst days, bending down to pick something up off the floor causes a sharp 8/10 pain in my right groin that radiates downward. I have to brace against a wall or furniture to straighten back up, and the pain lingers for 15-20 minutes afterward. I often cannot bend at all without pain.”
What the examiner listens for:
Consistent, specific description of pain onset with bending, severity, and duration. The examiner is checking the 'bending over' box on the DBQ only if you report pain with this activity.
Understatements to avoid:
Saying 'it bothers me a little when I bend' without specifying severity or impact. Do not minimize by saying you 'manage' to bend - describe what it actually costs you physically.
Pain with Activities of Daily Living (ADLs)
How to describe:
Per Note (2) under DC 7338, ANY ONE of bathing, dressing, hygiene, or transfers qualifies. Describe specifically which ADL causes pain and how. For example: putting on pants or shoes, stepping into a bathtub, transferring from a chair, or reaching to wash yourself in the shower.
Worst-day example:
“On bad days, putting on my pants and socks causes a stabbing 7/10 pain at the hernia site because bending and lifting my leg aggravates it. Getting in and out of the bathtub is also extremely painful - I have had to install grab bars because of this. Sometimes I need help from my spouse to dress.”
What the examiner listens for:
Specific ADL activities that trigger hernia pain, and functional dependence or modifications made as a result. The examiner checks the ADL box based on your report.
Understatements to avoid:
Saying 'I can still do everything, it just hurts.' Describe the modifications, workarounds, or assistance you require. Do not skip this category because ADLs are a critical checkbox on the DBQ.
Pain with Walking
How to describe:
Specify how far you can walk before pain starts (in blocks, minutes, or steps), the severity of pain when it occurs, whether you use any assistive devices, and whether you have changed your walking pattern (limp, shortened stride) because of the hernia.
Worst-day example:
“On my worst days, I can walk maybe half a block before I get a 6/10 aching and pressure pain in my lower abdomen at the hernia. I end up walking hunched slightly forward to reduce the pulling sensation. I have stopped going for walks entirely because I know it will cause significant pain that lingers for hours.”
What the examiner listens for:
Onset distance of pain, gait changes, and avoidance behaviors tied directly to hernia-related pain rather than other conditions.
Understatements to avoid:
Saying 'I can walk fine' if you actually experience pain at any point during walking. Even if you push through pain, it is still pain - report it accurately.
Pain with Climbing Stairs
How to describe:
Describe whether you have pain climbing up, going down, or both, which leg or movement triggers it, the severity, and whether you avoid stairs entirely or limit yourself to one flight.
Worst-day example:
“On my worst days, climbing even one flight of stairs causes immediate 7/10 sharp pain at the hernia site with each step up. I grip the railing tightly and sometimes have to stop halfway. At home I avoid the upstairs entirely on bad days.”
What the examiner listens for:
Whether stair climbing reliably produces hernia pain, the severity, and any adaptive behavior (avoiding stairs, using elevator, gripping railing).
Understatements to avoid:
Saying 'stairs are fine' because you can technically do them. If you experience pain, discomfort, or pressure during stair climbing, accurately describe it.
Hernia Duration and Recurrence
How to describe:
Clearly state when the hernia was first diagnosed, whether it has been present continuously, and if it is a recurrence after surgery. Emphasize if the total duration is 12 months or more, as this is a required threshold for all rating levels above 0%.
Worst-day example:
“My hernia was first diagnosed in 2019 and I had a repair in 2020, but it recurred in 2021 and has been present since - now over three years. My surgeon has told me further repair is not recommended at this time due to the recurrence risk and my other health conditions.”
What the examiner listens for:
Documented or reported duration of at least 12 months, and whether the hernia is a new occurrence or a recurrence after surgical repair. Recurrence after repair qualifies as an irreparable hernia for rating purposes.
Understatements to avoid:
Failing to mention the duration or omitting surgical history. Do not assume the examiner has reviewed your full records - verbally confirm how long you have had the hernia.
Hernia Size on Worst Days
How to describe:
Describe how the hernia presents when it is at its largest - typically after being on your feet all day, after physical activity, or at the end of the day. Note any variation in size between morning and evening. Bring prior medical records documenting measured size.
Worst-day example:
“By the end of the day after I have been on my feet, the bulge is noticeably larger and feels like it is about the size of a fist. My last clinical note from 2023 documented it at approximately 8 cm. In the morning it is smaller but never fully goes away.”
What the examiner listens for:
Consistent description of hernia size at its largest versus its smallest, and medical records corroborating the reported size. The examiner will measure on exam day but must also document the date and source of size measurement.
Understatements to avoid:
Only describing the hernia when it is at its smallest (e.g., lying down in the morning). Per M21-1 guidance, the examiner should evaluate the worst-day presentation. Ask to be measured standing and while bearing down.
Common Mistakes to Avoid
Reporting only how you feel on a good day
The VA rates based on the overall severity of your condition including your worst days. Under M21-1 guidance, examiners are instructed to note the full range of severity. If you only describe good days, the DBQ will reflect a milder condition than you actually experience.
Instead: Explicitly tell the examiner: 'On my worst days, which occur [frequency], my symptoms include...' Describe both your average presentation and your worst-day presentation separately.
Impact: All levels - can reduce rating by one or more tiers
Not addressing all four pain activity categories separately
The DBQ has four separate checkboxes for bending, ADLs, walking, and climbing stairs. The number of boxes checked directly determines your rating tier. If you only describe pain generally without addressing each activity, the examiner may not check all applicable boxes.
Instead: Before the exam ends, go through all four activities with the examiner: 'I want to make sure we discussed bending, daily activities like dressing, walking, and climbing stairs separately.' Confirm each one has been addressed.
Impact: Can be the difference between 20% and 60% or 100%
Failing to state hernia duration explicitly
The 12-month duration requirement is a hard threshold for all ratings above 0%. If duration is not documented, the examiner may not record it, and the rater may deny a higher rating.
Instead: State directly and clearly: 'This hernia has been present continuously for [X years/months] since [date].' If it is a recurrence, state: 'This is a recurrent hernia after my repair in [year], and the recurrence has been present for [duration].'
Impact: All levels above 0%
Being measured only while lying down
Hernias often reduce when lying supine, resulting in a smaller or absent measurement that does not reflect your true functional status. This can push you into a lower size threshold.
Instead: Ask the examiner to measure you standing upright and while performing a Valsalva maneuver (bearing down as if having a bowel movement). Bring prior imaging or clinical notes showing a larger measured size.
Impact: Can be the difference between 3 cm, 15 cm, and smaller size thresholds - affecting every rating tier
Not mentioning failed surgical repair or surgical ineligibility
Irreparability is a required criterion for 30% and above. If you had a repair that failed (recurrent hernia) or have been told you are not a surgical candidate, this must be clearly stated. The examiner must document the explanation of irreparability on the DBQ.
Instead: Bring surgical records. State clearly: 'I had a repair on [date] that failed and the hernia recurred' or 'My surgeon told me I am not a candidate for repair because [reason].' Ask the examiner to document this.
Impact: 30%, 60%, 100%
Omitting the impact of hernia on ADLs because the activities seem mundane
Veterans often underreport pain with bathing, dressing, and hygiene because they feel these activities are too minor to mention. However, under DC 7338 Note (2), pain with ANY ONE of these qualifies the ADL checkbox, which can be the tipping point for a higher rating.
Instead: Think through your morning routine and report any hernia-related pain with dressing, bathing, using the toilet, or transferring in and out of chairs or vehicles. Report it accurately to the examiner.
Impact: 20% to 30%, 30% to 60%, or 60% to 100%
Not requesting to be examined in person if a telehealth exam is scheduled
Physical examination is essential for hernia evaluation - the examiner must measure the hernia, assess reducibility, and perform a physical exam. A records-only or telehealth exam without physical findings may result in an incomplete DBQ and a lower rating.
Instead: If notified of a telehealth format, request an in-person examination. Document this request in writing. The DBQ asks whether the veteran was examined in person, and the format of the exam is noted.
Impact: All levels
Prep Checklist
Before Your Exam
Day Of
During the Exam
After the Exam
Your Rights During a C&P Exam
- You have the right to request an in-person physical examination rather than a telehealth or records-only review, particularly for a condition requiring physical measurement such as a hernia.
- You have the right to request a copy of the completed DBQ after the examination. Submit this request to the VA regional office or your accredited claims agent or VSO.
- You have the right to record your C&P examination in most states. Check your state's specific recording consent laws before doing so. If your state requires one-party consent, you may record without notifying the examiner. If two-party consent is required, inform the examiner at the start.
- You have the right to bring a support person to your C&P examination. They may be asked to wait outside the exam room during the physical portion but can be present for the interview portion in many cases.
- You have the right to submit a written statement correcting inaccuracies in the DBQ or examination report by submitting a Statement in Support of Claim (VA Form 21-4138) or equivalent.
- You have the right to request a new or additional examination if you believe the initial exam was inadequate, failed to address all rating criteria, or was conducted in a manner inconsistent with VA examination standards (e.g., not measuring the hernia in a standing position).
- You have the right to submit private medical opinions from your own treating physicians that may provide a more thorough or accurate assessment of your hernia severity.
- You have the right to appeal an unfavorable rating decision through the Supplemental Claim, Higher-Level Review, or Board of Veterans Appeals lanes under the Appeals Modernization Act.
- You are not required to answer questions unrelated to the claimed condition. If questions seem unrelated, you may ask the examiner to clarify how the question relates to your hernia claim.
- The benefit of the doubt standard applies to your claim: when there is an approximate balance of positive and negative evidence, the VA must resolve that doubt in your favor under 38 CFR 3.102.
Related Conditions
- Hiatal Hernia and Paraesophageal Hernia A separate diagnostic code (DC 7346) applies to hiatal and paraesophageal hernias, which are rated under esophageal stricture criteria rather than DC 7338. If you have both a hiatal hernia and an abdominal/inguinal hernia, they are rated separately.
- Muscle Hernia (Extensive) Extensive muscle hernias are rated under DC 5326 (38 CFR 4.73) at 10% without other muscle injury. This is a musculoskeletal rather than digestive system condition and is rated separately from abdominal hernias under DC 7338.
- Chronic Abdominal Pain / Bowel Obstruction Hernias can cause secondary conditions including bowel obstruction, incarceration, or chronic abdominal pain syndromes. These complications may be ratable as separate secondary service connected conditions if caused by the service connected hernia.
- Post-Surgical Neuropathic Pain (Ilioinguinal Neuralgia) Following inguinal hernia repair, nerve damage to the ilioinguinal or genitofemoral nerve can cause chronic neuropathic pain in the groin, inner thigh, or scrotum. This may be ratable as a separate secondary condition under peripheral nerve diagnostic codes.
- Chronic Back Pain or Lumbar Strain Hernias, particularly large ventral or incisional hernias, can alter posture and gait, contributing to or aggravating lumbar strain or back pain. If your hernia has caused or worsened your back condition, a secondary service connection claim may be appropriate.
- Postoperative Residuals (Mesh Complications) Veterans who have undergone hernia repair with surgical mesh may develop mesh related complications including chronic pain, infection, mesh migration, or adhesions. These residuals may support a higher rating or a separate secondary claim.
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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.