Following successful surgical treatment of an inguinal hernia (ie, preparing the defect), there should be no ratable impairment unless there is clearly recognized nerve injury or a complication such as infection. The AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Fifth and Sixth Editions, provide guides to the rating of permanent impairment for hernias. Both stress that impairment evaluation is predicated on the existence of a causal relationship between the individual's condition and an event or exposure. If a patient has an appropriate repair, then the defect should be resolved; that is, there should be no physical examination findings of a palpable deficit nor of a protrusion. If a palpable defect is present and the hernia is causally related to an injury, then the hernia is ratable. As with all ratings, the underlying basis must be reliable; that is, the history, including reported activities of daily living (ADL), must be supportable. In the AMA Guides, Fifth Edition, three examples show ratings, all of which depend on objective findings of palpable defects (protrusions). The sixth edition outlines the assignment of one of four classes of findings and interferences with ADLs. Impairment is based on objective findings when the individual is at maximum medical improvement.