Citation Nr: 18146161 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 16-15 484 DATE: October 30, 2018 ORDER The claim of entitlement to service connection for a hysterectomy as secondary to service-connected disability of ovarian cysts, status post removal, is granted. FINDINGS OF FACT 1. The Veteran is in receipt of service connection for ovarian cysts. 2. The Veteran’s hysterectomy is caused by the service connected ovarian cyst removal. CONCLUSION OF LAW The criteria for establishing entitlement to service connection for a hysterectomy have been met. 38 U.S.C. §§ 1110 and 5107 (2012); 38 C.F.R. §§ 3.102 and 3.310 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had honorable service with the United States Army from March 1983 to March 2007. The Veteran appeals the rating decision from July 2014 from the Regional Office in St. Petersburg, Florida. No hearing was requested. The Veteran was previously service-connected for the removal of ovarian cysts in April 2007. The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to notify and assist Veterans in substantiating a claim for VA benefits. 38 U.S.C. §§ 5102 and 5103 (2018); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2018). In this case, the Board is granting in full the benefit sought on appeal. Assuming, arguendo, that any error was committed with respect to the duty to notify or the duty to assist, such error was harmless and non-prejudicial and will not be further discussed. Secondary Service Connection The Veteran contends that the hysterectomy is eligible for secondary service connection since it was preformed to alleviate the Veteran of the same medical issues that the primary service connection was granted for. To prevail on the issue of secondary service connection, the record must show evidence of a current disability, evidence of a service-connected disability, and medical nexus evidence establishing a connection between the current disability and the service-connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). The Veteran states that she suffered from the residual effects of a hysterectomy that she underwent after she retired from the Army. The Veteran contends that they underwent this procedure due to complications from the removal of ovarian cysts during service. In order to prove secondary service connection for a disability, the Veteran must first prove that they have a current disability. The Veteran here had a hysterectomy in December 2007 to alleviate a fibroid and a cystic mass in and around the uterus. In 2013, the Veteran submitted a statement in support of their claim stating that their condition is worsening. The Veteran also noted that she is suffering negative side-effects since her hysterectomy in a Compensation and Pension Exam from October 2016. There is ample evidence to show that the Veteran currently is suffering from the residual effects of their hysterectomy. As such, the first element of the service connection is met. The second element required for secondary service connection requires that there is a service connected injury, disease or injury that the additional service-connected disability may have impacted. Here, the Veteran was granted service connection for removal of ovarian cysts with an effective date in April 2007. This service connection was granted on a rating decision from June 2007. The Veteran states that her hysterectomy was done due to the cysts that were present on her ovaries. This removal of the ovarian cysts will function as the primary disability upon which the Veteran’s secondary service connected disability is claimed to be connected. The third element required for a valid secondary service connection is a nexus between the second issue and the directly service-connected disability. The Veteran was service connected for the removal of ovarian cysts in April 2007. The Veteran contends here that her hysterectomy from December 2007 is secondary to her service connected ovarian cyst removal. Throughout the Veteran’s service, she was treated for a variety of issues regarding her ovaries, uterus, and reproductive system in general. The Veteran’s doctor stated in January 2015 that it was in his medical opinion that these issues were caused by military service and resulted in the complete hysterectomy in December 2007. The doctor notes the removal of the ovarian cyst in 1982, the abnormal pap smear from 1990, and the right ovarian cyst drainage that occurred during the tubal ligation in 1997. The doctor fails to mention the lower pelvic pain that was reported in 2000, the yeast infections from 1994, and the note of two cysts on her ovaries from 1989. Still, the doctor stated that he was also the Veteran’s flight surgeon when she was in service and that he summarized her medical history for retirement. Even without basing his medical opinion on those other details, the doctor was able to affirmatively state that the Veteran’s in-service ovarian issues resulted in the hysterectomy that the Veteran underwent not a year after leaving service. Because the doctor is competent, credible, and knew the Veteran when she was in service, his statements bear significant probative weight when considering whether the hysterectomy is secondarily connected to service through the primary service connected cyst removal disability. Here, the Veteran left service in March 2007. She was service connected for the removal of ovarian cysts effective April 2007. The cysts were removed in January 1997. The Veteran was then noted to have a fibroid and a cystic mass on the uterus in a recent ultrasound taken in November 2007. The Veteran then underwent a total hysterectomy in December 2007 to remedy the issue. Taking the Veteran’s medical history, along with the statement by the Veteran’s at-time in-service doctor and current familial medicine doctor into account, it is apparent that a nexus exists between the Veteran’s service connected cyst removal disability and the complaint for secondary service. The Veteran suffered a variety of complications with her reproductive system throughout her period of service. There is highly probative evidence supporting the Veteran’s claim that the hysterectomy that she underwent in December 2007 is secondarily connected to the cyst removal disability for which she is already service connected. Upon careful review of the record, the Board finds that the evidence in this claim for secondary service connection for the Veteran’s total hysterectomy is, at minimum, in equipoise. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107 (2012); 38 C.F.R. § 3.102 (2018); see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). As such, entitlement to secondary service connection is established. B. MULLINS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. N. P. Jochem, Associate Counsel