Citation Nr: 0813771 Decision Date: 04/25/08 Archive Date: 05/01/08 DOCKET NO. 06-36 317 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection for residuals of a hysterectomy. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD A. Cryan, Associate Counsel INTRODUCTION The veteran served on active duty from January 1970 to February 1972. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2005 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The veteran testified at a Travel Board hearing before the undersigned Acting Veterans Law Judge (VLJ) in June 2007. The Board notes that the veteran withdrew her appeal for the issue of entitlement to service connection for a cardiovascular disability at the time she submitted her substantive appeal in September 2005. She confirmed her desire to withdraw the cardiovascular issue at the time of the Travel Board hearing. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND The veteran also alleges that her hysterectomy in 1982 was related to gynecological symptoms and abdominal pain that she had in service. The veteran's service medical records (SMRs) reveal that the veteran was seen in service with complaints of intermittent right lower quadrant pain worse during menstruation twice in November 1970. She reported chronic right lower quadrant pain worse during menses again in March 1971. She was assessed with questionable endometriosis or possible gastrointestinal disease. She reported severe right-side pain in April 1971. In June 1971 she reported a seven month history of right lower quadrant pain with increased vaginal discharge. She was assessed with chronic pelvic inflammatory disease. Finally, in February 1972 the veteran reported lower abdominal pain and nausea on two occasions. She was assessed with questionable premenstrual cramps or pelvic inflammatory disease. VA outpatient treatment reports associated with the claims file reveal that the veteran was assessed with a probable fibroid and menorrhagia in May 1972 and underwent a dilation and curettage (D & C) at that time. Private treatment reports from Orange Park Medical Center dated in June 2005 reveal that the veteran's past surgical history included a hysterectomy and two oopherectomies. The veteran testified at a Travel Board hearing in June 2007. She reported that she began having abdominal pain and vaginal bleeding in service. She said she went to sick call several times and was given medication or sent on her way. The veteran testified that she continued to have vaginal bleeding after service and underwent a D & C in May 1972 at a VA hospital. She indicated that she was informed that she had a fibroid. Later, a private physician told her she had fibroids. She stated that she had a hysterectomy in 1982 at a private hospital and then had her left ovary removed in 1995 and her right ovary removed in 2002. The veteran indicated she said she was not afforded a VA examination in order to assess her claim of service connection for residuals of a hysterectomy. Given the veteran's in-service complaints, and her lay assertions of a continuity of symptomatology between service and her surgery, the Board finds that an examination is necessary prior to final appellate review. See Charles v. Principi, 16 Vet. App. 370 (2002) (Holding that under 38 U.S.C.A § 5103A(d)(2), VA was to provide a medical examination where, the claimant had been diagnosed to have tinnitus, and had proffered competent lay evidence that he had had continuous symptoms of the disorder [i.e., ringing in the ears] since his discharge). See also McClendon v. Nicholson, 20 Vet. App. 79 (2006) (recognizing that the "may be associated" element under § 5103A(d)(2) is a low threshold). Accordingly, the case is REMANDED for the following action: 1. The veteran should be afforded a VA gynecology examination. The examiner should review the claims file, to include the veteran's service medical records. The examiner should take a detailed history from the veteran. The examiner is requested to provide an opinion as to whether the need to perform a hysterectomy was at least as likely as not related to any symptoms or complaints noted in service. The report of examination must include the complete rationale for all opinions expressed. (The veteran is hereby notified that it is the veteran's responsibility to report for the examination and to cooperate in the development of the case, and that the consequences of failure to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. §§ 3.158 and 3.655 (2007).) 2. Thereafter, review the claims file to ensure that the requested development has been completed. In particular, review the examination report to ensure that it is responsive to and in complete compliance with the directives of this remand, and if it is not, take corrective action. 3. After undertaking any other development deemed appropriate, re- adjudicate the issue on appeal. If the benefit sought is not granted, the veteran and her representative should be furnished with a supplemental statement of the case and afforded an opportunity to respond before the record is returned to the Board for further review. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2007). _________________________________________________ MICHAEL LANE Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2007).