Citation Nr: 18148743 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 15-34 753 DATE: November 8, 2018 ORDER The claim for service connection for Bell’s palsy is denied. The claim for service connection for vulvovaginitis is denied. The claim for service connection for disease of cervix is denied. The claim for service connection for uterine displacement is denied. The claim for service connection for is residuals of pregnancy complications is denied. The claim for service connection for urethrovaginal fistula is denied. REMANDED The claim for higher ratings in excess of 10 percent prior to April 8, 2011, and 60 percent since, for asthma with chronic bronchitis is remanded. The claim for a compensable rating for right breast excision of benign fibroadenoma is remanded. The petition to reopen the claim for service connection for a heart disorder to include myocardial infarction is remanded. INTRODUCTION The Veteran served on active duty from May 2000 to May 2005. This matter comes before the Board of Veterans’ Appeals (Board) from May 2012 and July 2014 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). FINDINGS OF FACT 1. There is no competent medical evidence of vulvovaginitis. 2. There is no competent medical evidence of disease of the cervix. 3. There is no competent medical evidence of uterine displacement. 4. There is no competent medical evidence of residuals of pregnancy complications. 5. There is no competent medical evidence of urethrovaginal fistula. 6. The record does not contain objective medical evidence of in-service treatment, findings or diagnoses of neurological problems; or a medical opinion providing a nexus between Bell’s palsy and injury or disease during the Veteran’s active service. CONCLUSIONS OF LAW 1. The criteria for service connection for vulvovaginitis have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.310. 2. The criteria for service connection for disease of the cervix have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.310. 3. The criteria for service connection for uterine displacement have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.310. 4. The criteria for service connection for residuals of pregnancy complications have not been met. 38 U.S.C. §§ 1110, 5107; §§ 3.303, 3.310. 5. The criteria for service connection for urethrovaginal fistula have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.310. 6. The criteria for service connection for Bell’s palsy have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran claims that she has variously diagnosed gynecological disorders to include vulvovaginitis, disease of the cervix, uterine displacement, residuals of pregnancy complications, and urethrovaginal fistula, that are related to service connected endometriosis. She has indicated that she now has irregular menstrual cycles, pelvic pain, and suffered a miscarriage secondary to endometriosis. She further claims that she has Bell’s palsy as a result of military service.   General laws and regulations that pertain to service connection In general, service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 38 C.F.R. § 3.303 (a). To establish entitlement to direct service connection for the claimed disability, there must be: (1) medical evidence of current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus or link between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004), citing Hansen v. Principi, 16 Vet. App. 110, 111 (2002). Service connection may be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. See 38 C.F.R. § 3.310 (a); see also Harder v. Brown, 5 Vet. App. 183, 187 (1993). Additional disability resulting from the aggravation of a non-service-connected condition by a service-connected condition is also compensable under 38 C.F.R. § 3.310 (a). See Allen v. Brown, 7 Vet. App. 439, 448 (1995). In order to establish entitlement to service connection on this alternative secondary basis, there must be: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a nexus (i.e., link) between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Alternatively, under 38 C.F.R. § 3.303 (b), service connection may be awarded for a “chronic” condition when (1) a chronic disease manifests itself and is identified as such in service, or within the presumptive period under 38 C.F.R. § 3.307, and the veteran presently has the same condition; or (2) a listed chronic disease (under 38 C.F.R. § 3.309 (a) manifests itself during service, or during the presumptive period, but is not identified until later, and there is a showing of continuity of related symptomatology after discharge, and medical evidence relates that symptomatology to the Veteran’s present condition. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (holding that the theory of continuity of symptomatology analysis is applicable in cases involving conditions explicitly recognized as chronic diseases under 38 C.F.R. § 3.309 (a)). Neurological disorders are listed among the “chronic diseases” under 38 C.F.R. § 3.309 (a); therefore, 38 C.F.R. § 3.303 (b) applies. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Significantly, in this case, no chronic disease (neurological) was identified during service. A veteran bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement. Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009); see also Walker, 708 F.3d at 1334. In making its ultimate determination, the Board must give a Veteran the benefit of the doubt on any issue material to the claim when there is an approximate balance of positive and negative evidence. Fagan, 573 F.3d at 1287 (quoting 38 U.S.C. § 5107 (b)). Entitlement to service connection for vulvovaginitis, disease of the cervix, uterine displacement, residuals of pregnancy complications, and urethrovaginal fistula The Veteran’s service treatment records (STRs) show that she was treated for urinary tract infections and variously diagnosed gynecological problems throughout service which included vaginitis (June 2000, February 2001, June 2004), vulval intraepithelial neoplasia (VIN) (February 2001), pelvic pain (September 2000), vulvar candida (January 2001, January 2004), left vulvar biopsy (February 2001), laser vaporization of the vulva (March 2001), laser ablation (April 2001), endometriosis (August through November 2002), and chlamydia (2002 and May 2005). In February 2003 during a pregnancy, the Veteran reported abdominal cramping and vaginal discharge. No diagnosis was recorded and the Veteran was reassured. From May to July 2003, the Veteran submitted statements from her private physician indicating that she was/should be assigned bedrest for minor complications with pregnancy. These minor complications were not explained. In August 2003 she delivered a normal spontaneous birth with no reported complications. In October 2003 she was seen for heavy menstrual bleeding. She underwent laparoscopy in August 2002 and July 2004 for endometriosis. She underwent examination in April 2005, pelvic examination was within normal limits. There were normal genitalia. The vaginal mucosa was well estrogenized without lesion. The cervix showed no lesion or discharge. The uterus was midline, mobile and nontender. The RO granted service connection for endometriosis in a May 2005 rating action. Post service record shows that VA gynecological examinations were conducted in August 2005, May 2006, and May 2007. VA outpatient as well as private medical records dated since service discharge to 2015 show that the Veteran has continued to complain of abdominal and pelvic pain. In January 2006, the RO denied service connection for VIN; yeast infection secondary to VIN; and urinary tract infection secondary to VIN. Private medical record shows that the Veteran underwent laser treatment for valvular dysplasia in June 2007. VA gynecological examination was conducted in September 2011. The Veteran reported her medical history. Since service discharge she continued to have pelvic pain. In 2003 she delivered a normal spontaneous birth. She reported undergoing 2 laparoscopies, one in 2004. She reported that she underwent laparoscopy in 2005. The Veteran reported that she had a miscarriage in July 2010; however, the examiner pointed that there was a decreasing HCG level but no visible pregnancy was ever entertained. She had no dilatation or curettage. The examiner determined that endometriosis did not cause uterine displacement, since it has not been shown by history or examination. The examiner stated that the pregnancy complications were the spontaneous miscarriages. Examination of the pelvic area was normal. The external genitalia were considered normal. The vaginal mucosa showed no lesions. The cervix was closed without lesion or bleeding. There was no evidence of cervix lesion or disease. The examiner noted the Veteran had HPV related to VIN 2 and 3 lesions, which was treated with laser. There were no sequelae from the laser treatment. There was no evidence of pelvic inflammatory disease or urethral vaginal fistula nor complications related to endometriosis. As explained, the most fundamental requirement for any claim for service connection is that the Appellant has the condition claimed. See Degmetich v. Brown, 8 Vet. App. 208 (1995); 104 F.3d 1328 (1997) (indicating VA compensation only may be awarded to an applicant who has disability existing on the date of application, not for past disability); see, too, McClain v. Nicholson, 21 Vet. App. 319 (2007) (further clarifying that this requirement of current disability is satisfied when the claimant has the disability at the time the claim for VA disability compensation is filed or during the pendency of the claim and that a claimant may be granted service connection even though the disability resolves prior to VA’s adjudication of the claim). Congress has specifically limited entitlement for service-connected disease or injury to cases where such incidents have resulted in disability. Brammer v. Derwinski, 3 Vet. App. 223 (1992); Rabideau v. Derwinski, 2 Vet. App. 141 (1992); Gilpin v. Brown, 155 F.3d 1353 (Fed. Cir. 1998). A current disability means a disability shown by competent medical evidence to exist. Chelte v. Brown, 10 Vet. App. 268 (1997). There is no competent evidence of the claimed disabilities (vulvovaginitis, disease of the cervix, uterine displacement, residuals of pregnancy complications, or urethrovaginal fistula) upon which to predicate a grant of service connection. The Veteran has neither provided nor identified any medical evidence showing that she has the claimed disabilities, separate from disability for which service connection is already in effect. Therefore, service connection cannot be granted. Without proof of a current disability, there can be no valid claim. Service connection for Bell’s Palsy A private medical report record dated in May 2012 includes a diagnosis of Bell’s palsy; this is over 6 years after service discharge, which is an extended period. This is prior to the Veteran’s claim for Bell’s Palsy. There is also no nexus opinion by any medical professional that links the Bell’s palsy to military service. The Veteran has not provided any competent medical evidence of a nexus between current disability and disease or injury during service, as required by Hansen/Shedden analysis. While the Veteran asserts that her disorder resulted from her service, as a lay person, however, she does not have the medical expertise to conclude that there is an etiological relationship between her disorder and military service. Medical diagnoses involve questions that are beyond the range of common experience and common knowledge, and require the knowledge and experience of a trained physician. Because it is not shown that the Veteran has expertise in medical matters, she is not competent to make a determination on the etiology of her claimed disorder. The Board is cognizant that a July 2015 VA examination was provided. The examiner noted the prior diagnosis, was noted that there was no association between the service-connected disabilities asserted to be the cause of the Bell’s Palsy and Bell’s Palsy. This is a negative opinion, considering the contentions on appeal. Further, the diagnosis was dated prior to the claim and the Board finds that there is no competent evidence of a current diagnosis or residual disability during the appellate period or a period relevant to the appellate period. On this basis, the Board finds that the claim must be denied and there is not a basis for remand to obtain an additional examination. Accordingly, the Board concludes that the preponderance of the evidence is against the claim for service connection for Bell’s palsy. Since the preponderance of the evidence is against the claim, there is no reasonable doubt to be resolved in her favor, and this claim must be denied. 38 C.F.R. § 3.102; Alemany v. Brown, 9 Vet. App. 518, 519 (1996). REASONS FOR REMAND A May 2005 rating action denied service connection for valvular heart disease claimed as leaky heart and heart murmur. The Veteran was notified later that month. She did not appeal this decision. In April 2011, the Veteran filed her current claim for service connection for myocardial infarction. Considering the broad scope of the May 2005 denial, i.e. there was no evidence of any heart disabilities, and the fact that the described symptoms in May 2005 are the same as those described now, the Board finds that the current claim for service connection for myocardial infarction is in fact a petition to reopen the previously denied claim, and therefore new and material evidence is required in this case. Boggs v. Peake, 520 F.3d 1330 (Fed. Cir. 2008); Clemons v. Shinseki, 23 Vet. App. 1, 5-8 (2009). Therefore, further development is needed. Examination is also needed to determine the current severity of the Veteran’s service connected bronchitis and scarring from the right breast excision of benign fibroadenoma. In June 2016, it appears the Veteran applied for vocational rehabilitation benefits. If a vocational rehabilitation folder has been generated, this should be included with the electronic file on return. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA Vocational Rehabilitation and Counseling folder and associate it with the e-file for consideration. 2. Thereafter, schedule the Veteran for appropriate VA examinations to determine the severity of her bronchitis and scarring from the right breast excision of benign fibroadenoma. All necessary diagnostic testing and evaluation should be performed, and all clinical findings reported in detail. If possible, the appropriate Disability Benefits Questionnaire (DBQ) should be completed for these disabilities.   3. The RO should readjudicate the Veteran’s petition to reopen a claim for service connection for a heart disorder. The RO should review the May 2005 RO decision regarding the claims for service connection for heart disorders. The RO should determine whether such claim has been reopened, and should give the Veteran information about both the May 2005 denial of service connection for a heart disorder and the notice that she was then given; the laws and regulations applicable to the finality of prior unappealed rating decision; and a discussion of the effect of the prior denial on the current claim. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A.D. Jackson, Counsel