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Indirect Inguinal Hernia

Occupational mechanical exposures — heavy lifting, carrying, and prolonged standing/walking characteristic of military duty — and their association with inguinal hernia requiring repair.

38 CFR diagnostic code 7338

Peer-reviewed evidence · 10 studies

Every one links to its record

  • Kuijer PPFM, Hondebrink D, Hulshof CTJ, Van der Molen HF. Work-relatedness of inguinal hernia: a systematic review including meta-analysis and GRADE. Hernia. 2020;24(5):943-950. PMID:32474653. doi:10.1007/s10029-020-02236-0.

  • Kang SK, Burnett CA, Freund E, Sestito J. Hernia: is it a work-related condition?. Am J Ind Med. 1999;36(6):638-44. PMID:10561684. doi:10.1002/(sici)1097-0274(199912)36:6<638::aid-ajim6>3.0.co;2-w.

  • Carbonell JF, Sanchez JL, Peris RT, Ivorra JC, Del Bano MJ, Sanchez CS, Arraez JI, Greus PC. Risk factors associated with inguinal hernias: a case control study. Eur J Surg. 1993;159(9):481-6. PMID:8274556.

Key facts

Diagnostic code
7338
Verified studies
10
Legal theories
Direct (§ 3.303)

Peer-reviewed evidence (10)

The verified studies behind an Indirect Inguinal Hernia claim — each links to its real PubMed or DOI record. These are sources our nexus drafts can draw from; none are invented.

  1. Kuijer PPFM, Hondebrink D, Hulshof CTJ, Van der Molen HF. Work-relatedness of inguinal hernia: a systematic review including meta-analysis and GRADE. Hernia. 2020;24(5):943-950. PMID:32474653. doi:10.1007/s10029-020-02236-0.
  2. Kang SK, Burnett CA, Freund E, Sestito J. Hernia: is it a work-related condition?. Am J Ind Med. 1999;36(6):638-44. PMID:10561684. doi:10.1002/(sici)1097-0274(199912)36:6<638::aid-ajim6>3.0.co;2-w.
  3. Carbonell JF, Sanchez JL, Peris RT, Ivorra JC, Del Bano MJ, Sanchez CS, Arraez JI, Greus PC. Risk factors associated with inguinal hernias: a case control study. Eur J Surg. 1993;159(9):481-6. PMID:8274556.
  4. Ashindoitiang JA, Ibrahim NA, Akinlolu OO. Risk factors for inguinal hernia in adult male Nigerians: a case control study. Int J Surg. 2012;10(7):364-7. PMID:22676975. doi:10.1016/j.ijsu.2012.05.016.
  5. Schwab R, Becker HP, Fackeldey V. Inguinal hernia repair in German military hospitals. Mil Med. 2004;169(12):962-5. PMID:15646186. doi:10.7205/milmed.169.12.962.
  6. Vad MV, Frost P, Bay-Nielsen M, Svendsen SW. Impact of occupational mechanical exposures on risk of lateral and medial inguinal hernia requiring surgical repair. Occup Environ Med. 2012;69(11):802-809. PMID:22935954. doi:10.1136/oemed-2012-100787.
  7. Vad MV, Frost P, Rosenberg J, Andersen JH, Svendsen SW. Inguinal hernia repair among men in relation to occupational mechanical exposures and lifestyle factors: a longitudinal study. Occup Environ Med. 2017;74(11):769-775. PMID:28546321. doi:10.1136/oemed-2016-104160.
  8. Vad MV, Frost P, Svendsen SW. Occupational mechanical exposures and reoperation after first-time inguinal hernia repair: a prognosis study in a male cohort. Hernia. 2015;19(6):893-900. PMID:25537572. doi:10.1007/s10029-014-1339-0.
  9. Liem MS, van der Graaf Y, Zwart RC, Geurts I, van Vroonhoven TJ. Risk factors for inguinal hernia in women: a case-control study. Am J Epidemiol. 1997;146(9):721-726. PMID:9366619. doi:10.1093/oxfordjournals.aje.a009347.
  10. Flich J, Alfonso JL, Delgado F, Prado MJ, Cortina P. Inguinal hernia and certain risk factors. Eur J Epidemiol. 1992;8(2):277-282. PMID:1644149. doi:10.1007/BF00144814.

Controlling law

The CFR sections and cases the theories relevant to this condition rest on — the legal standard raters evaluate against, never a prediction about any claim.

Direct (§ 3.303)

Regulation

  • 38 C.F.R. § 3.303

    Direct service connection — a current disability linked to service. (Continuity of symptomatology under § 3.303(b) is limited by case law to the § 3.309(a) chronic diseases — Walker.)

Case law

  • Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004)

    The three-element test: current disability, in-service event, and a nexus between them.

  • Holton v. Shinseki, 557 F.3d 1363 (Fed. Cir. 2009)

    Federal Circuit restatement of the same three direct-service-connection elements.

  • Caluza v. Brown, 7 Vet. App. 498 (1995)

    The evidentiary framework a rater weighs each element against.

  • Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013)

    Continuity of symptomatology (§ 3.303(b)) is available ONLY for a chronic disease listed in § 3.309(a); any other condition must use the medical-nexus pathway.

  • Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009)

    A categorical 'a medical opinion is always required for nexus' is legal error — competent lay evidence can suffice.

  • Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465 (1994)

    A veteran is competent to report symptoms they personally observe (Layno), and lay evidence can even establish a simple diagnosis in the right case (Jandreau).

  • McLendon v. Nicholson, 20 Vet. App. 79 (2006)

    A LOW threshold — evidence that merely indicates a nexus MAY exist obligates VA to provide a C&P exam.

  • 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990)

    When the evidence is in relative equipoise, the tie goes to the veteran — the preponderance must be AGAINST the claim to deny it.

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Educational information about the evidentiary standard — not legal or medical advice, and never a prediction about any claim.

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