Citation Nr: 18145394 Decision Date: 10/30/18 Archive Date: 10/26/18 DOCKET NO. 14-39 434 DATE: October 30, 2018 REMANDED Service connection for vision loss is remanded. Service connection for a gynecological condition, with symptoms that include pain, menses, cramping, and heavy bleeding, is remanded.   REASONS FOR REMAND The Veteran served on active duty from August 2003 to July 2005. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. The Board has expanded the claim on appeal to one for service connection for a gynecological condition, with symptoms that include pain, menses, cramping, and heavy bleeding. This is necessary to reflect the broader scope of the claim intended by the Veteran. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (when a claimant makes a claim, she is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled). The change is also reflected the remand section. 1. Service connection for vision loss is remanded The Veteran seeks service connection for vision loss. In a November 2014 substantive appeal, the Veteran explained that as part of her military service duties as an aviation maintenance administrationman she spent a considerable amount of the time using a computer. This involved drafting and proofreading computer-based summaries, reports, and other documents. The Veteran reports that as a consequence of “excessive computer use” she developed myopia, astigmatism, or blurred vision. She maintains that blurred vision was a work-related stress injury if diagnosed with computer-related eye strain, which is “referred to as computer vision syndrome.” The Veteran’s personnel records are consistent with her report of using a computer throughout her service. Her service treatment records (STRs) do not reflect a diagnosis of computer related-eye strain. However, she underwent a vision examination during service in September 2003 at which time her vision in at least one eye was measured as worse than when examined at entrance in November 2002. The Board cannot make a fully-informed decision on the issue of because no VA examiner has opined whether her computer use may have caused a computer-related eye strain and, if so, whether this was an injury that caused superimposed worsening during service. 2. Service connection for a gynecological condition, with symptoms that include pain, menses, cramping, and heavy bleeding, is remanded. The Veteran maintains that she currently has a gynecological condition that is related to her military service. In the November 2014 substantive appeal, the Veteran reported experiencing symptoms of abdominal pain, fatigue, diarrhea, bloating, and excessive bleeding. Additionally, the Veteran states that she experienced infertility issues for the last three years. She asserts that her current condition developed as a result of the “stressful and straining physical requirements such as heavy lifting and physical training” in the military. Further, she contends that an April 2013 VA gynecological examination was inadequate because the examiner did not perform any invasive tests, such as, a laparoscopy or an ultrasound. The Veteran was afforded a VA gynecological examination in April 2013. The examiner noted the Veteran’s complaints of “moderate pain.” The Veteran reported taking motrin to treat her pain. The examiner documented no history of endometriosis. In the remarks, the examiner stated that the “Veteran has dysmenorrhea with no diagnosis of endometriosis. Therefore, this does not represent a gynecological disability.” Once VA has provided a VA examination, it is required to provide an adequate one, regardless of whether it was legally obligated to provide an examination in the first place. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Further, an examination that provides an etiology opinion without a rationale is inadequate. Stefl v. Nicholson, 21 Vet. App. 120 (2007). Here, although a formal diagnosis of endometriosis was not made, the Veteran asserts that she experiences functional impairment associated with a gynecological condition. If that impairment is associated with an in-service event, service connection may be warranted. See Saunders v. Wilkie, 2018 U.S. App. LEXIS 8467, *18-28 (Fed. Cir. Apr. 3, 2018) (holding that pain resulting in functional impairment constitutes a disability as contemplated in 38 U.S.C. § 1110, even in the absence of a presently-diagnosed condition). Because the April 2013 examination did not address this question, it is inadequate, and remand for an additional examination and opinion is required. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any vision condition. The examiner must address each of the following: (a.) Opine whether the Veteran’s computer use during service resulted in an injury to her vision, such as a computer-related eye strain. (b.) If so, did that injury result in a superimposed worsening of her vision during service? 2. Schedule the Veteran for a VA examination to ascertain the nature and etiology of her gynecological condition. All indicated tests and studies should be conducted and all clinical findings reported in detail. (a.) Please identify by medical diagnosis the Veteran’s gynecological condition, if any. If a diagnosis cannot be made, please describe the nature and degree of functional impairment associated with the reported symptoms. (b.) For each diagnosis and/or functional impairment, the examiner should state whether it is at least as likely as not that the gynecological condition was incurred in or caused by an in-service event? Please explain why or why not. In providing this opinion, the examiner is to consider the Veteran’s competent lay statements, including the November 2014 substantive appeal. The examiner is asked to explain why her statements make it more or less likely that a condition started during service. If indicated, it should be explained whether there is a **medical** reason to believe that the Veteran’s recollection of his symptoms during and after service may be inaccurate or not medically supported as the onset or cause of his current diagnosis. (c.) Please indicate whether a laparoscopy or an ultrasound was performed during the examination. Alternatively, please explain why a laparoscopy or an ultrasound was not medically indicated. (Continued on the next page)   The examiner should describe the nature and extent of the Veteran’s gynecological condition and symptoms. To the extent possible, the examiner should distinguish symptoms due to other service-connected disabilities. If this is not possible, the examiner should identify all symptoms that overlap. C. BOSELY Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD I. Altendorfer, Associate Counsel