Citation Nr: 18148792 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 13-08 574 DATE: November 8, 2018 ORDER Entitlement to service connection for an ovarian cyst condition with pelvic pain is granted. FINDING OF FACT The Veteran has pelvic pain secondary to an ovarian cyst condition that developed during active service. CONCLUSION OF LAW The criteria for entitlement to service connection for ovarian cyst condition with pelvic pain have been met. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from November 1988 to July 1992. 1. Entitlement to service connection for gynecological condition to include pelvic pain, hysterectomy, abnormal menses The Veteran contends that she underwent a hysterectomy as a result of gynecological conditions that developed during active service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran has current symptoms of pelvic pain that are related to an ovarian cyst that developed during active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). However, the preponderance of the evidence weighs against finding that the Veteran’s hysterectomy and endometriosis occurred during service or are otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Prior to entry in the United States Army, the Veteran underwent a tubal ligation procedure in March 1988. The Veteran’s service treatment records (STRs) reflect treatment visits for abnormal menses, and pelvic pain. A pelvic ultrasound was performed in February 1990, which showed an “unremarkable exam,” other than a left ovarian cyst. Post-service, 1993 and 1994 treatment records show complaints of cramps during menses. The Veteran was diagnosed with various gynecological conditions over these years including dysmenorrhea, polycystic ovaries, endometriosis, and tubo ovarian sterile abscess. In September 1994, the Veteran underwent a laparoscopic pelvic procedure during which the uterosacral nerves were treated with bipolar electrocautery. The Veteran’s partial hysterectomy, during which one fallopian tube was removed, was performed in March 2009. In January 2011, August 2011, and June 2013 the Veteran complained of unusual menstrual bleeding. In the Veteran’s October 2016 hearing testimony, she claimed to still suffer from cramps but not bleeding. The Veteran was afforded a VA examination in November 2017. The examiner opined that the Veteran’s current pelvic pain was at least as likely as not due to the ovarian cyst that was discovered during active service when the Veteran reported irregular menses and pelvic pain. However, the VA examiner opined that the Veteran’s endometriosis and hysterectomy are not at least as likely as not related to an in-service injury, event, or disease, including the pre-existing tubal ligation. The rationale was that the diagnosed conditions of endometriosis and partial hysterectomy occurred after separation from active service and that they are unrelated to the tubal ligation procedure. The examiner also noted that the Veteran had a normal pap and breast examination one month prior to separation from active service. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). While the Veteran is competent to report having gynecological symptoms intermittently since service, she is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of a tubal ligation or resulted in a hysterectomy or to provide a nexus opinion. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the VA examiner’s opinion. Accordingly, the Board finds that entitlement to service connection for the Veteran’s current pelvic pain related to ovarian cyst is warranted, and the appeal is granted as to this condition. However, as the weight of the evidence is against a   finding that her endometriosis and hysterectomy are etiologically related to service. Accordingly, service connection for endometriosis and hysterectomy is denied. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Miller, Associated Counsel