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C&P Exam Prep: Hernias

DC 7339 digestive 38 CFR 4.114

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 nature, severity, size, reducibility, and functional impact of your hernia for VA disability rating purposes under 38 CFR - 4.114, Diagnostic Code 7338. The examiner will determine hernia type, whether it is reparable or irreparable, its physical dimensions, associated pain with specific activities, and how it limits your daily functioning.

What the examiner evaluates:

  • Hernia type (inguinal, femoral, umbilical, ventral, incisional, or other)
  • Whether the hernia is reparable or irreparable
  • Physical size of the hernia in at least one dimension (in centimeters)
  • Duration of the hernia (whether present 12 months or more)
  • Pain when bending over
  • Pain with activities of daily living (bathing, dressing, hygiene, transfers)
  • Pain when walking
  • Pain when climbing stairs
  • Surgical history, including prior repair attempts and recurrence
  • Current medications for the condition
  • Functional limitations and impact on employment and daily life
  • Whether the hernia is new, recurrent, or post-surgical
  • Whether bilateral hernias are present (each side evaluated separately)
  • Any complications such as incarceration, strangulation, or bowel involvement
  • Nexus to military service or a service-connected condition

The exam will include a physical examination of the abdomen and groin region. You may be asked to stand, cough, or bear down (Valsalva maneuver) to demonstrate the hernia. Wear comfortable, loose-fitting clothing that allows easy access to the abdomen and groin. You may also be asked to walk, bend, or simulate stair climbing to demonstrate functional limitations.

Typical duration: 30 minutes

Hernia Size Measurement

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.

Key thresholds:

  • Less than 3 cm in one dimension — Supports lower rating tiers; does not meet 3 cm or 15 cm thresholds for higher ratings under DC 7338
  • 3 cm or greater but less than 15 cm in one dimension — Supports mid-range rating criteria under DC 7338 (20-60% range depending on additional factors)
  • 15 cm or greater in one dimension — Critical threshold - required element for 100% rating when combined with pain in at least three qualifying activities, present for 12+ months

Tips:

  • If your hernia is larger when you have been on your feet all day, mention this to the examiner before the exam begins
  • Ask the examiner to measure during standing and with Valsalva maneuver, not only while lying down, as hernias may reduce when supine
  • Bring any prior imaging reports (CT scan, ultrasound) that document hernia size, especially if prior measurements were larger
  • If the hernia has been documented as a specific size in prior medical records, reference those records
  • Note and report if the hernia appears larger during flare-ups or after prolonged activity

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

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.

Key thresholds:

  • Reducible hernia — Generally supports lower rating tiers unless surgical repair is not feasible
  • Irreducible/incarcerated hernia — Supports higher rating tiers; irreparability is a required element for 100% rating under DC 7338
  • Irreparable hernia (present 12+ months) — Required criterion for 100% rating when combined with size -15 cm and pain in 3+ qualifying activities

Tips:

  • If your hernia has ever been incarcerated or strangulated, report this history clearly
  • If a surgeon has told you the hernia is inoperable or that surgery carries too great a risk, bring documentation of this
  • Report any prior failed repairs that have resulted in recurrence
  • Note if you wear a truss or hernia belt - this may indicate the hernia requires ongoing mechanical support

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

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.

Key thresholds:

  • Pain in 1 of 4 qualifying activities — Does not meet multi-activity pain criterion for highest rating tiers
  • Pain in 2 of 4 qualifying activities — Supports mid-range ratings; does not reach 3-activity threshold for 100% rating
  • Pain in 3 or 4 of the 4 qualifying activities — Critical threshold - required element for 100% rating when combined with size -15 cm and irreparability for 12+ months

Tips:

  • Think through each activity separately before the exam and have specific examples of how each causes pain
  • For ADLs, note that bathing, dressing, hygiene tasks, and transfers all count - any one is sufficient
  • Describe the character of pain for each activity (sharp, dull, burning, stabbing, pressure)
  • Report pain that occurs during AND after the activity (delayed onset pain counts)
  • Note if you have modified or avoided any of these activities entirely due to anticipated pain

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.

Estimate

Rating Criteria Breakdown

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 following activities: bending over, activities of daily living (ADLs), walking, and climbing stairs.

Key Symptoms

  • Hernia confirmed irreparable by medical professional
  • Hernia present (new or recurrent) for 12 or more continuous months
  • Hernia size 15 cm or greater in at least one measured dimension
  • Pain with bending over (present 12+ months)
  • Pain with ADLs - bathing, dressing, hygiene, or transfers (present 12+ months)
  • Pain with walking (present 12+ months)
  • Pain with climbing stairs (present 12+ months)
  • At least three of the four pain activities must be present

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 ...

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).

Key Symptoms

  • Hernia confirmed irreparable
  • Present for 12 or more months
  • Hernia size between 3 cm and 14.9 cm in one dimension
  • Pain with at least three of the four qualifying activities present for 12+ months
  • Significant functional limitation in daily activities

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 ...

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.

Key Symptoms

  • Irreparable hernia present 12+ months
  • Hernia size 3 cm or greater but less than 15 cm in one dimension
  • Pain with at least two qualifying activities
  • Moderate functional limitation

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 ...

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.

Key Symptoms

  • Irreparable hernia present 12+ months
  • Size 3-14.9 cm with pain in at least one qualifying activity, OR size under 3 cm with pain in at least three qualifying activities
  • Mild to moderate functional restriction

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 small ...

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.

Key Symptoms

  • Irreparable hernia present 12+ months
  • Size less than 3 cm
  • Pain in at least two qualifying activities
  • Minimal but documented functional limitation

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. ...

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.

Key Symptoms

  • Hernia present but reparable
  • No pain or insufficient pain in qualifying activities
  • Hernia present less than 12 months
  • Hernia repaired with no residuals

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%.

How to Describe Your Symptoms

Pain with Bending Over

How to describe:

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.

Worst-day 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.”

What the 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.

Understatements to 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:

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.

Worst-day 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.”

What the 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.

Understatements to 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:

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.

Worst-day 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.”

What the 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.

Understatements to 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:

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.

Worst-day 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.”

What the 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.

Understatements to 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:

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.

Worst-day 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.”

What the 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.

Understatements to 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:

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.

Worst-day 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.”

What the 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.

Understatements to 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.'

Common Mistakes to Avoid

Prep Checklist

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Before Your Exam

Day Of

During the Exam

After the Exam

Your Rights During a C&P Exam

  • You have the right to have a representative (VSO, attorney, or claims agent) accompany you to the C&P exam.
  • You have the right to request a copy of the completed DBQ following the examination through a FOIA or Privacy Act request.
  • You have the right to record the examination in most states - check your state's recording consent laws before doing so.
  • You have the right to request a new C&P examination if the original DBQ contains inadequate findings, errors, or fails to address all of your claimed symptoms.
  • You have the right to submit a buddy statement (VA Form 21-10210) from a family member, friend, or caregiver who can attest to the severity and duration of your hernia symptoms.
  • You have the right to submit a personal statement (VA Form 21-4138 or 21-10210) describing your symptoms and correcting any inaccuracies in the examiner's findings.
  • You have the right to have your claim decided based on the benefit of the doubt - if evidence is in equipoise, the VA must resolve the question in your favor (38 U.S.C. - 5107(b)).
  • You have the right to an adequate examination - an examiner cannot rely solely on a records review if a physical examination is necessary to assess your hernia's size, reducibility, and functional impact.
  • You have the right to challenge an inadequate, inaccurate, or incomplete DBQ through a supplemental claim, higher-level review, or Board of Veterans' Appeals appeal.
  • You have the right to have all symptoms evaluated at their worst presentation - per M21-1 guidance, the rating should reflect the full severity of the disability, not a single snapshot on an atypically good day.

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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.