Citation Nr: 18142620 Decision Date: 10/17/18 Archive Date: 10/16/18 DOCKET NO. 16-33 395 DATE: October 17, 2018 REMANDED Entitlement to service connection for uterine fibroids is remanded. Entitlement to service connection for residuals of hysterectomy, to include intermittent pelvic pain and sexual and genitourinary dysfunction, is remanded. Entitlement to service connection for prolapsed bladder, to include as due to hysterectomy, is remanded. REASONS FOR REMAND The Veteran served in the United States Navy from December 1984 to December 1992. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. The Board notes that there were additional issues denied in this rating decision, however, the Veteran limited her to appeal to the issues reflected above. While the Board sincerely regrets further delay, additional development is required before the Veteran’s claims may be adjudicated on the merits. 1. Entitlement to service connection for uterine fibroids is remanded. 2. Entitlement to service connection for residuals of hysterectomy, to include intermittent pelvic pain and sexual and genitourinary dysfunction is remanded. 3. Entitlement to service connection for prolapsed bladder, to include as due to hysterectomy is remanded. Specifically, on the Veteran’s July 2016 VA Form 9 Substantive Appeal, she indicated that she was receiving private medical treatment and would provide additional medical evidence. However, a review of the record indicates that no attempt was made to provide the Veteran with a VA Form 21-4142a authorization to release outstanding treatment records. Accordingly, a remand is required to attempt to obtain these outstanding private treatment records in order to satisfy VA’s duty to assist. 38 U.S.C. § 5103A. Additionally, the Board notes that to date, the Veteran has not received a VA examination in connection with her claims. The Veteran had documented uterine fibroids in-service, beginning in 1988. The Veteran underwent a myomectomy in June 1991 to remove the fibroids. Following the Veteran’s discharge from service, the Veteran and her representative assert that her fibroids were not cured by the June 1991 myomectomy and subsequently resulted in the Veteran requiring further surgery. In 1994, the Veteran had a hysterectomy, in 2000 she had a bilateral oophorectomy, and a colporrhaphy in 2003. See, July 2018 VA 646 Statement of Accredited Representation. The Veteran and her representative assert that as a result of the original uterine fibroids and subsequent remedial surgeries, the Veteran suffers from moderate pelvic pain two to three times per week which requires treatment with over the counter medications and sexual and genitourinary dysfunction. Id. As the Board finds that the medical evidence of record does not contain sufficient competent medical evidence to determine if the Veteran has any current residuals resulting from her documented in-service uterine fibroids, to include residuals of hysterectomy and bladder prolapse, an examination is warranted. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson 20 Vet. App. 79, 81 (2006). The matters are REMANDED for the following action: 1. Send the Veteran VA Forms 21-4142 and 21-4142a and request that she identify private treatment providers who may have records pertinent to her remanded claims. She should be provided an appropriate amount of time to respond. 2. Regardless of whether or not additional records are obtained, schedule the Veteran for a VA examination with appropriate medical personnel in order to determine if her uterine fibroids and any residuals, hysterectomy, and bladder prolapse are etiologically related to her active duty service, to include the in-service documented treatment of uterine fibroids. The Veteran’s entire claims file, to include a copy of this remand, should be provided to the examiner. Following a complete review of the record, the examiner is asked to provide the following opinions: a. Whether or not the Veteran has a current uterine fibroid disability, to include any residuals. b. If a uterine fibroid disability is present, is it at least as likely as not related to the Veteran’s active duty service, and specifically, her documented treatment of uterine fibroids while in service. Even if there is no diagnosed disorder, pain resulting in functional impairment may constitute a disability for service-connection purposes. If present, describe any functional impairment; if not, state why. c. Determine if the Veteran has any residuals from a hysterectomy, to include intermittent pelvic pain and sexual and genitourinary dysfunction. d. If any residuals from the hysterectomy are present, is it at least as likely as not that the residuals are related to the Veteran’s active duty service, and specifically, her documented treatment of uterine fibroids while in service. Even if there is no diagnosed disorder, pain resulting in functional impairment may constitute a disability for service-connection purposes. If present, describe any functional impairment; if not, state why. e. Determine if the Veteran has a current diagnosis of bladder prolapse. f. If the Veteran does have a diagnosis of bladder prolapse, is it at least as likely as not that the residuals are related to the Veteran’s active duty service, and specifically, her documented treatment of uterine fibroids while in service. All opinions provided must be supported by a complete rationale and must address the Veteran’s statements regarding the onset of her uterine fibroids and the complications that followed. If the examiner must resort to speculation for any of the requested opinions, an explanation as to why this is so is required. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Daugherty, Associate Counsel