Citation Nr: 18140076 Decision Date: 10/02/18 Archive Date: 10/02/18 DOCKET NO. 15-33 748 DATE: October 2, 2018 REMANDED Entitlement to compensation under 38 U.S.C. § 1151 for additional disability due to a total hysterectomy at the Baltimore VA Medical Center (VAMC) in July 2011 is remanded. REASONS FOR REMAND The Veteran served in the Reserve and National Guard and was on active duty from January 1989 to January 1993. This appeal to the Board of Veterans’ Appeals (Board) is from a May 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to compensation under 38 U.S.C. § 1151 for additional disability due to a total hysterectomy at the Baltimore VAMC in July 2011 is remanded. A VA examination was conducted in May 2015 to determine if the July 2011 surgery for a total hysterectomy resulted in additional disability for which the Veteran is entitled compensation. The clinician provided an unfavorable opinion concerning a serosal tear that occurred during the surgery, but did not address whether VA treatment associated with the July 2011 surgery resulted in additional disability that was not a reasonably foreseeable. Furthermore, there appears to be some inconsistency between the clinician’s report of the facts and the operation report. In this regard, the clinician stated that there was a minor serosal tear that did not require surgery. The operation report, however, states that a 4-cm segment of the serosal was injured and that this was repaired and sutured. It is unclear whether there is any significance to this discrepancy, so clarification is needed. The clinician also provided conflicting information regarding the Veteran’s double bowel syndrome, which involves constipation, diarrhea, and abdominal pain. Under the section for signs and symptoms, the clinician identified the Veteran’s double bowel syndrome as associated with her intestinal surgery, but under the remarks section the clinician stated the Veteran’s bowel complaints are secondary to double bowel syndrome and not sequela of her prior surgery. Clarification is needed since an opinion would be required if the double bowel syndrome is related to the July 2011 surgery. The matter is REMANDED for the following action: Return the claims file to the VA physician, if available, who examined the Veteran and provided an opinion in May 2015 to get an addendum. After reviewing the file, the physician is asked to respond to the following: a) Since the May 2015 VA examination report states the Veteran’s double bowel syndrome is associated with her surgery but also states it is not sequela of the surgery, clarification is needed as to whether it is related to the July 2011 surgery for the total hysterectomy. • If it is associated with the surgery, opine whether the double bowel syndrome is at least as likely as not (50 percent probability or greater) an additional disability caused by the July 2011 surgery. • Opine on whether the proximal cause of the double bowel syndrome is at least as likely as not carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on VA’s part (i.e., did VA fail to exercise the degree of care that would be expected of a reasonable healthcare provider). • Is the double bowel syndrome not a reasonably foreseeable outcome of the July 2011 surgery? b) Opine whether the serosal bowel injury is at least as likely as not an additional disability caused by the July 2011 surgery, and whether it is not a reasonably foreseeable outcome of the July 2011 surgery. • The May 2015 examination report states the serosal tear did not require surgical correction, but the operation report indicates the tear was repaired with sutures. Please clarify whether this notation in the operation report was considered is providing the previous opinions. If not considered, please consider it and make any adjustment to the prior opinion, if needed. (Continued on the next page)   c) The physician must include adequate rationales that support all opinions expressed. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Bredehorst