Citation Nr: 0306239 Decision Date: 04/01/03 Archive Date: 04/10/03 DOCKET NO. 00-20 686A ) DATE ) ) On appeal from the Department of Veterans Affairs Medical and Regional Office Center in Wichita, Kansas THE ISSUES 1. Entitlement to service connection for a hysterectomy. 2. Entitlement to service connection for a psychiatric disorder. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant, Appellant's Husband ATTORNEY FOR THE BOARD K . L. Wallin, Associate Counsel INTRODUCTION The veteran served on active duty from February 1962 to September 1964. This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from an April 1999 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina, which found that new and material evidence had not been submitted to reopen claims of entitlement to service connection for a hysterectomy and major depression/generalized anxiety disorder. In an August 2002 decision, the Board found that new and material evidence had been submitted with respect to the aforementioned issues. The Board then undertook development on the reopened claims of entitlement to service connection for a hysterectomy and major depression/ generalized anxiety disorder pursuant to authority granted by 38 C.F.R. § 19.9(a)(2). The matter is now ready for appellate disposition. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable resolution of the issues on appeal has been obtained. 2. A hysterectomy is related to the veteran's period of active duty service. 3. Major depression is due to menstrual problems, which began in service and resulted in the veteran undergoing a hysterectomy. CONCLUSIONS OF LAW 1. A hysterectomy was incurred in service. 38 U.S.C.A. §§ 1110, 1112, 1154 (West 1991 & Supp. 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2002). 2. Major depression is the result of the service-connected hysterectomy. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.310 (2002). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In view of the favorable disposition of the issues resolved in this determination, the Board finds that further development under the Veteran's Claims Assistance Act of 2000 (VCAA) and/or previously existing law is not necessary. The veteran essentially contends that she is entitled to service connection for a hysterectomy and major depression/generalized anxiety disorder. Specifically, she contends that her post-service hysterectomy was the result of excessive bleeding during service. She further contends that her major depression/generalized anxiety disorder is a result of her hysterectomy. Laws and regulations Service connection for VA compensation purposes will be granted for a disability resulting from disease or personal injury incurred in the line of duty or for aggravation of a preexisting injury in the active military, naval or air service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). When a veteran seeks service connection for a disability, due consideration shall be given to the supporting evidence in light of the places, types, and circumstances of service, as evidenced by service records, the official history of each organization in which the veteran served, the veteran's military records, and all pertinent medical and lay evidence. See 38 U.S.C. § 1154; 38 C.F.R. § 3.303(a). To establish service connection for a disability, a claimant must submit (1) medical evidence of a current disability, (2) medical evidence, or in certain circumstances lay testimony, of in-service incurrence or aggravation of an injury or disease, and (3) medical evidence of a nexus between the current disability and the in-service disease or injury. See Pond v. West, 12 Vet. App. 341, 346 (1999). Where the determinative issue involves a medical diagnosis, competent medical evidence is required. This burden may not be met by lay testimony because laypersons are not competent to offer medical opinions. Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). I. Entitlement to service connection for a hysterectomy. The Board has thoroughly reviewed all the evidence of record, and in accordance with pertinent statutes and regulations, finds that service connection is warranted for a hysterectomy. In this regard, the veteran's service medical records reveal that the veteran complained of vaginal bleeding, discharge, and cramping. In June 1963, the veteran was diagnosed with dysfunctional vaginal bleeding. Her August 1964 separation examination was normal. In the veteran's October 2000 RO hearing, she testified that she had excessive menstrual bleeding and cramping subsequent to her discharge from service, for which she sought treatment. She indicated that the private physicians were either deceased or retired and thus, their records were unavailable. She then testified that she developed endometriosis in 1970, which ultimately led to her hysterectomy. Private medical records from Providence Hospital confirm that the veteran had a total abdominal hysterectomy and left salpingo-oophorectomy in July 1975. These records also indicate that in April 1977, the veteran underwent a laparotomy with right oopherctomy. Upon VA examination in February 1994, the veteran was diagnosed with remote endometriosis with subsequent hysterectomy. During VA examination in November 1995, the veteran reported her menstrual problems during service, as well as subsequent to her discharge, and leading up to her hysterectomy. Finally, pursuant to Board development, the veteran was afforded a VA examination in January 2003. The veteran reported that during her active duty service she began having extremely heavy menstrual bleeding. She further indicated that her heavy menstrual bleeding and cramping persisted subsequent to her discharge from service. The veteran also indicated that she was diagnosed with endometriosis and later underwent a hysterectomy. The examiner reviewed the veteran's claims folder and opined, that it was as least likely as not that the gynecological problems the veteran had over the years, to include dysfunctional uterine bleeding in service, are what led to her hysterectomy. Therefore, resolving all reasonable doubt in favor of the veteran, and based on the aforementioned evidence, service connection is granted for a hysterectomy. See 38 C.F.R. §§ 3.102, 3.303. II. Entitlement to service connection for major depression/generalized anxiety disorder. The veteran contends that her major depression and generalized anxiety disorder are a result of her ongoing gynecological problems. Specifically, she has asserted that her depression is a direct result of in-service vaginal bleeding which ultimately led to her post-service hysterectomy. The Board has thoroughly reviewed all the evidence of record, and in accordance with pertinent statutes and regulations, finds that service connection is warranted for major depression/generalized anxiety disorder on a secondary basis. In this regard, a disability, which is proximately due to, or the result of a service connected disease or injury shall be service connected. See 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence sufficient to show: (1) that a current disability exits, and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Id. In the instant decision, the Board has found that service connection is warranted for a hysterectomy. Based on the evidence discussed below, the Board finds that the veteran's currently diagnosed major depressive disorder and generalized anxiety disorder were caused by the service-connected hysterectomy. Id. VA outpatient treatment records dated from 1985 to 1998 confirm the veteran's treatment for depression and anxiety. These records repeatedly note that the veteran was status post-hysterectomy. In addition, the aforementioned records contain diagnoses of major depression, anxiety, situational anxiety disorder, generalized anxiety disorder, and dysthymia. VA also hospitalized the veteran for depression in February 1997, October 1998, and November 1998. A letter from Dr. J.H.H. dated in December 1993, reveals that the veteran was totally disabled since June 1993 due to her major depression, generalized anxiety disorder, and dysthymia. Private medical records from Dr. J.H.H., indicate that the veteran received psychotherapy from April 1982 until November 2000. Upon VA examination in February 1994, the veteran relayed a history of depression, which began after her hysterectomy. She was diagnosed with long standing depression. In November 1995, the veteran was afforded a VA examination for mental disorders. The veteran again relayed a history of menstrual problems beginning in service, continuing after her discharge, and leading up to her hysterectomy. She was diagnosed with chronic major depression and generalized anxiety disorder. Private medical records from Providence-St. Margaret Health Center indicate that the veteran was admitted for major depression and generalized anxiety disorder in January 1993 and September 1995. These records note the veteran's post- service hysterectomy. In October 2000, the veteran presented testimony before the RO. She testified that she was forced into early menopause due to her hysterectomy, which ultimately led to her depression. Records from the Social Security Administration (SSA) indicate that the veteran was awarded disability compensation for depression in February 1999. SSA found that she was disabled as of June 1993. Their decision was based on VA outpatient treatment records, testimony of the veteran, private medical records, and a January 1994 psychological evaluation ordered by them. A December 2001 medical opinion from Dr. C.E.A., indicates that the veteran was seen in his office for consultation regarding previous medical treatment. The veteran's surgeries for gynecological disorders and treatment for anxiety and depression were noted. Dr. C.E.A. opined that while he was unable to specifically relate her depressive anxiety to her prior surgical treatments, he felt these conditions could certainly be related to removal of body organs and "might very well result in depressive disorder." In April 2002, Dr. C.E.A. indicated that since his December 2001 letter, "information has revealed the military hospitalization and treatment of the [the veteran] for dysfunctional uterine bleeding and pelvic pain." He indicated that these on-going symptoms and complaints eventually resulted in gynecological surgical treatments, which revealed the presence of endometriosis. He opined, "in view of the sequence of medical diagnosis and treatments, it is [his] medical opinion that [the veteran's] subsequent treatment bears a strong cause and effect relationship to her later developments of depression and anxiety." Dr. C.E.A. further opined, that it was his medical opinion that the veteran's hospitalization for gynecological treatments could have been signs and symptoms of the subsequent diagnosis of endometriosis, "which could very well be associated with her diagnosis of depression and anxiety." Finally, pursuant to Board development, the veteran was afforded a VA examination in January 2003. The examiner noted that an extensive review of the veteran's claims folder was made. The veteran relayed a history of long standing depression stemming from her in-service vaginal bleeding and hysterectomy. The examiner diagnosed the veteran with major depressive disorder, recurrent and chronic, with onset related to menstrual problems that started while the veteran was on active duty and resulted in her having to undergo a hysterectomy. Therefore, resolving all reasonable doubt in favor of the veteran, and based on the aforementioned evidence, service connection is granted for major depression/generalized anxiety disorder. See 38 C.F.R. §§ 3.102, 3.310. ORDER Entitlement to service connection for a hysterectomy is granted. Entitlement to service connection for major depression is granted. John E. Ormond, Jr. Veterans Law Judge, Board of Veterans' Appeals IMPORTANT NOTICE: We have attached a VA Form 4597 that tells you what steps you can take if you disagree with our decision. We are in the process of updating the form to reflect changes in the law effective on December 27, 2001. See the Veterans Education and Benefits Expansion Act of 2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the meanwhile, please note these important corrections to the advice in the form: ? These changes apply to the section entitled "Appeal to the United States Court of Appeals for Veterans Claims." (1) A "Notice of Disagreement filed on or after November 18, 1988" is no longer required to appeal to the Court. (2) You are no longer required to file a copy of your Notice of Appeal with VA's General Counsel. ? In the section entitled "Representation before VA," filing a "Notice of Disagreement with respect to the claim on or after November 18, 1988" is no longer a condition for an attorney-at-law or a VA accredited agent to charge you a fee for representing you.