Citation Nr: 18151367 Decision Date: 11/20/18 Archive Date: 11/16/18 DOCKET NO. 17-43 193 DATE: November 20, 2018 ORDER Service connection for endometriosis with infertility is granted. Service connection for a left wrist cyst is denied. Service connection for carpal tunnel syndrome of the left upper extremity is denied. An initial, compensable disability rating for migraines is denied. REMANDED Service connection for an acquired psychiatric disorder, to include depression is remanded. FINDINGS OF FACT 1. Giving the Veteran the benefit of the doubt, endometriosis with infertility, developed during service. 2. The preponderance of the evidence is against finding that the Veteran has a left wrist cyst due to service. 3. The preponderance of the evidence is against finding that the Veteran has carpal tunnel syndrome of the left upper extremity due to service. 4. For the entire appeal period, the Veteran’s migraines have not been manifested by prostrating attacks. CONCLUSIONS OF LAW 1. The criteria for service connection for endometriosis with infertility have been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 3.309, 3.310 (2017). 2. The criteria for service connection for left wrist cyst have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2017). 3. The criteria for service connection for carpal tunnel syndrome of the left upper extremity have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 3.309, 3.310 (2017). 4. The criteria for an initial, compensable disability rating for migraines have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.3, 4.7, 4.124a, Diagnostic Code 8100 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty, including from May 2002 to May 2010. Service Connection 1. Service connection for endometriosis with infertility. The Veteran contends that she has endometriosis with infertility due to service. The Board concludes that the Veteran has a current diagnosis of endometriosis with female infertility that began 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). The Veteran is already separately service-connected for polycystic ovarian syndrome. The August 2016 VA examination shows that the Veteran has a current diagnosis of endometriosis and infertility. The VA examiner opined that the Veteran’s infertility began in service, noting that service treatment records and VA medical records document that she was diagnosed and treated for infertility in service. The VA examiner did not provide an opinion specifically on endometriosis and service treatment records do not document treatment for endometriosis. However, a September 2013 VA medical record documents that the Veteran’s infertility is due to bilateral tubal blockage. A November 2015 VA medical record documents that at attempt to open her fallopian tubes failed due to scarring. Subsequent VA medical records, such as from February 2016, indicate that the Veteran’s infertility is related to her endometriosis. Given that the Veteran was treated for infertility in service, that the VA examiner found that the Veteran’s infertility developed during service, and the VA medical records indicate that endometriosis caused such infertility, and giving the Veteran the benefit of the doubt, the Board finds that service connection for endometriosis with infertility is warranted. 2. Service connection for a left wrist cyst. The Veteran asserts that she has a left wrist cyst due to 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 does not have a current diagnosis of a left wrist cyst and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). Service treatment records do not document complaints of, or treatment for, a left wrist cyst. The November 2009 medical board examination did not indicate any skin or left wrist disorders, and the Veteran did not report such a disorder. The February 2010 physical evaluation board similarly did not indicate any skin or left wrist disorders. Following her May 2010 separation from service, VA medical records do not document any complaints of, or treatment for, a left wrist cyst. An April 2012 VA vesting evaluation did not include any complaints regarding a skin disorder or cyst. Subsequent VA medical records are generally negative as to any skin complaints, other than regarding post-service bug bites to areas of the body that did not include the left wrist (in September and October 2013). The duty to assist under 38 U.S.C. § 5103A(d) and 38 C.F.R. § 3.159(c)(4) is triggered when it is necessary to obtain an examination to decide in the case. As there is no evidence of in-service or post-service left wrist cyst, a VA examination is not indicated. Although the Veteran claims that she has a current diagnosis of left wrist cyst, the Board finds such a report to not be credible, given the negative service treatment records and post-service VA medical records, which specifically include multiple negative findings regarding a skin disorder (other than bug bites) or disorder of the left wrist. Indeed, the Veteran has sought treatment for skin disorders after service, but for bug bites, not a left wrist cyst. As the preponderance of the evidence is against the claim, the benefit of the doubt rule does not apply. The Veteran’s claim for service connection for left wrist cyst is denied. 3. Service connection for carpal tunnel syndrome of the left upper extremity. The Veteran contends that service connection for carpal tunnel syndrome of the left upper extremity is warranted. The Board notes that in an April 2017 rating decision, the RO granted service connection for carpal tunnel syndrome of the right upper extremity. The Board must determine 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, even if the Veteran clearly had a diagnosis of carpal tunnel syndrome of the left upper extremity, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton, supra.; 38 C.F.R. § 3.303(a), (d). An March 2016 VA medical record documents that the Veteran had a provisional diagnosis of carpal tunnel syndrome of the left upper extremity. Even if the Board were to give her the benefit of the doubt as to having a diagnosis of carpal tunnel syndrome of the left upper extremity, her claim would still fail. Unlike the already service-connected carpal tunnel syndrome of the right upper extremity, the service treatment records do not document any findings of carpal tunnel syndrome of the left upper extremity. The December 2009 medical evaluation board proceedings showed that she had right upper extremity carpal tunnel syndrome, but made no findings regarding the claimed left upper extremity. Service treatment records are similarly negative as to complaints of, or treatment for, carpal tunnel syndrome of the left upper extremity. For years following service, the record is also silent for any complaints of, or treatment for, carpal tunnel syndrome of the left upper extremity, including no reports of chronicity by the Veteran. As noted above, even in March 2016, several years following her May 2010 discharge from service, the Veteran only had a provisional diagnosis of carpal tunnel syndrome. As there is no evidence of in-service of carpal tunnel syndrome of the left upper extremity or indication of it for years following service, and no probative medical evidence indicating that such disorder may have begun during service, the duty to assist under 38 U.S.C. § 5103A(d) and 38 C.F.R. § 3.159(c)(4) to obtain a VA examination is not indicated to decide in this case. The only evidence supportive of the Veteran’s claim is her lay claim that she has carpal tunnel syndrome of the left upper extremity due to service. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, a current diagnosis of carpal tunnel syndrome of the left upper extremity and an etiological opinion as to its development, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer); see also Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). In this regard, a diagnosis of carpal tunnel syndrome is based on medical knowledge, including neurological evaluation. Although the Veteran believes she has carpal tunnel syndrome of the left upper extremity related to service, the Board reiterates that the preponderance of the probative evidence weighs against findings that such a disorder developed during or would otherwise be due to service. 4. An increased rating for migraines. The Veteran contends that a compensable disability rating is warranted for her service-connected migraines. Under Diagnostic Code 8100 for migraines, any compensable disability rating requires characteristic prostrating attacks at a minimum, in conjunction with other requirements for each rating. The record does not show reports of, or finding of, prostrating attacks. The August 2016 VA examiner specifically found no prostrating attacks. Although VA medical records document occasional complaints of or treatment for migraines, they do not document any reports of prostrating attacks or findings of prostrating attacks. As the record does not support finding that the Veteran has prostrating attacks, the preponderance of the evidence is against the claim, the benefit of the doubt rule does not apply. The Veteran’s claim for an initial, compensable disability rating for migraines is denied. REASONS FOR REMAND 1. Service connection for an acquired psychiatric disorder, to include depression, is remanded. The Veteran has claimed that her depression began during service. Also, a November 2015 VA medical record indciates that such disorder may be due to her infertility issues. The Board cannot make a fully-informed decision on the issue of service connection for an acquired psychiatric disorder because no VA examiner has opined on such disroder. In a February 2016 VA medical record, the Veteran indicated that she had received counseling from the age of 10 through her teen years and that she believed that she had been followed for depression in service. A remand is required to allow VA to obtain authorization and request these records. Any unassociated service treatment records (including claimed treatment for depression if such records exist) and VA medical records should be obtained and associated with the claims file. The matters are REMANDED for the following actions: 1. Any unassociated VA medical records should be obtained and associated with the claims file. 2. Any unassociated service treatment records (to include claimed depression treatment) should be obtained and associated with the claims file. If no additional service treatment records exist, such a determination should be noted in the claims file. 3. Ask the Veteran to complete a VA Form 21-4142 for any private mental health counseling, including counseling reported to her February 2016 VA medical provider. Make two requests for the authorized records from any identified facilities, unless it is clear after the first request that a second request would be futile. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any acquired psychiatric disorder, to include depression. The claims file should be reviewed. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease. The examiner should also opine as to whether it is at least as likely as not (1) proximately due to service-connected gynecological disabilities, or (2) aggravated beyond its natural progression by service-connected gynecological disabilities. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Lindio