Inguinal, femoral, umbilical, ventral and incisional hernias claimed for VA disability are documented on this 8-page questionnaire. For each type the clinician records surgery dates and type, whether a current or recurrent hernia is present and when it was documented, whether it is repairable or irreparable and why, the size of an irreparable hernia, and whether it causes pain with daily activities, bending, stairs or walking.
The Veteran's treating or examining clinician completes the form and signs the Section X examiner's certification. The Veteran fills in no part of it.
Download the current version from the source each time; forms change without notice.
Hernias (Including Abdominal, Inguinal and Femoral Hernias) Disability Benefits Questionnaire
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The examiner considers whether that type of hernia can usually be repaired surgically, any medical records that already classify it as repairable or irreparable, and significant medical contraindications to surgery. The form asks for the date and source of the irreparable determination and an explanation for each side.
Yes. Section V covers umbilical, ventral, incisional and other hernias, with the type of hernia, surgery dates and types, whether a current or recurrent hernia is documented, and repairability, size and activity-related pain for any irreparable hernia. Scars from the repair need the dermatological questionnaire.