Muscle Hernias

Topics:

General Muscle Hernias
Diaphragm
Other Hernias
Principles that Apply

Reminder: The VA will give a Military Disability Rating for each service-connected condition a service member has, but the DoD will only rate service-connected conditions that make a service member Unfit for Duty.

 


General Muscle Hernias

Code 5326: A hernia is the protrusion of an organ through the wall of the cavity that normally contains it. The most common types of hernias involve the abdominal cavity and are rated under other codes on the Digestive System page. These include inguinal hernias, femoral hernias, ventral hernias, and hiatal hernias.

All other types of hernias are rated under this code, but they are rare. Hernias that have not been or cannot be repaired are rated 10%. No rating is given for repaired and healed hernias, but if there are lasting symptoms caused by the hernia, like decreased organ function or muscle damage, they are rated separately.

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Diaphragm

The diaphragm is a muscle that separates the chest cavity from the abdominal cavity.

Code 5324: A hernia of the diaphragm is a hole in the diaphragm that allows the organs in the abdomen to move into the chest. This code does not have its own ratings. Instead, it is rated as a hiatal hernia. The final code for this condition will look like this: 5324-7346. The first four-digit code defines it as a hernia of the diaphragm, and the second four-digit code tells how it is rated.

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Other Hernia Conditions

All hernias that affect the digestive system are rated on The Digestive System page. All other muscle hernia conditions will be rated analogously with the above ratings. The bottom line rule is to rate any condition under the code that BEST describes it, even if it is not exact.

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Principles that Apply

Combined Ratings for Muscle Injuries: A rating for a muscle hernia cannot be combined with a rating for any other muscle condition unless each condition affects completely different functions or muscle groups (i.e. a hernia condition in the abdomen makes it hard to bend forward and another muscle condition in the abdomen affects posture).

Pyramiding: A single condition can only be rated once! However, if a nerve condition or other condition exists that is additional to the hernia condition (not simply caused by it), then it can also be rated.

Painful Motion: If pain is present with motion, then the minimum compensable rating (at least 10%) must be given.

Probative Value: If two exams record the condition differently, the exam with the most thorough data and performed by the most qualified person in that specialty will be the exam the rating is based on.

A Tie Goes to the Veteran: If there are two equally strong exams with conflicting information, or if the condition can be equally rated under two different codes, then the one that gives the highest rating will be assigned. Every conflict should be resolved in favor of the higher rating.

Hospital or Convalescent Ratings: Some conditions require periods of hospitalization or constant medical care (at-home nurse, etc.). Any condition that requires this is rated 100% during this intensive treatment. Once it ends, then the 100% rating will continue for a certain period. This period is 3 months unless another length (6 months, 1 year, etc.) is directly specified in the condition ratings. Some patients may need more time to recover than others, so the physician or Rating Authorities can lengthen this time period if they see fit.

Please see the Musculoskeletal Principles and the VASRD Principles pages for further guidance.

For cancer affecting the diaphragm or other muscles, please see the Cancer and Tumors of the Musculoskeletal System page. For hernias affecting the digestive system, see The Digestive System page.

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