Citation Nr: 18151217
Decision Date: 11/16/18	Archive Date: 11/16/18

DOCKET NO. 11-03 947
DATE:	November 16, 2018
REMANDED
Entitlement to service connection for residuals of tubal ligation is remanded.
REASONS FOR REMAND
The Veteran had active military service from August 1979 to August 1982 with subsequent National Guard and Reserve service. 
These matters come before the Board of Veterans’ Appeals (Board) on appeal from a February 2010 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO).
The Veteran testified before the undersigned Veterans Law Judge in May 2013; a transcript of the hearing is associated with the claims file.  The Board remanded the claim in July 2014, June 2016, and March 2018.  Unfortunately, another remand is required for the reasons indicated below.
1. Entitlement to service connection for residuals of tubal ligation is remanded.
The Veteran contends that she has residuals of tubal ligation for which she should be service-connected. Specifically, the Veteran claims that she had a copper intrauterine device (IUD) inserted during service, which later resulted in inflammation of her left fallopian tube, for which she had to have surgery, and experienced subsequent infertility.
A September 2012 VA examination report reflects a diagnosis of fallopian tube obstruction. The examiner noted that the Veteran had an IUD inserted in 1980 while stationed in Germany, and had it removed in 1986 to attempt pregnancy. In 1988, she underwent a hysterosalpingogram (HSG) showing hydrosalpinx (distally blocked fallopian tube filled with serous or clear fluid) in the left tube. She had two tuboplasties in 1990, but was never able to conceive. She denied a history of sexually transmitted disease or pelvic inflammatory disease. The examiner did not provide an opinion.
In May 2018, the Veteran submitted a statement explaining that her private treatment records from 1988 and 1990 had been destroyed. In addition, the Veteran contended that the cooper IUD she had inserted is known to cause infertility.
Given the Veteran’s statements that her infertility is due to the cooper IUD she had inserted during service; her consistent statements that she underwent a HSG and tuboplasties as a result of scars in the left fallopian tube due to the IUD; and the lack of medical opinion addressing whether the Veteran’s infertility is a result of or caused by the IUD she had inserted during service; the Board finds that a remand is required for a medical opinion. See McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also Barr v. Nicholson, 21 Vet. App. 30 (2007) (holding that once VA undertakes the effort to provide an examination or obtain medical opinion, it must ensure that one is provided or obtained that is adequate for the determination being made).
The matter is REMANDED for the following action:
1. Refer the Veteran’s claims file to an appropriate physician, to address the nature and etiology of the Veteran’s residuals of tubal ligation, to include infertility. All necessary tests should be conducted.
The claims file and a copy of this REMAND must be sent to the examiner for review. 
The examiner should address whether any residuals of tubal ligation, to include infertility, is as least as likely as not (50 percent probability or more) related to her in-service cooper-7 IUD.
The Veteran’s post-service treatment records are unavailable and the VA examiner should not base his/her reasoning solely on a lack of post-service treatments, complaints, and diagnosis. A complete rationale should accompany any opinion provided.
The examiner is advised that the Veteran is competent to report symptoms, treatments, and injuries, and that her reports must be taken into account in formulating the requested opinion.
 
Jonathan Hager
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	L. Leifert, Associate Counsel