Citation Nr: 18153072 Decision Date: 11/28/18 Archive Date: 11/27/18 DOCKET NO. 14-44 041 DATE: November 28, 2018 ORDER Entitlement to service connection for a heart condition, claimed as mitral valve prolapse, is denied. Entitlement to service connection for endometriosis is denied. Entitlement to service connection for residuals of fibroid tumors, also claimed as severe colon tumors, status post small bowel resection, sigmoid colectomy, and maturation of colostomy stoma is granted. Entitlement to service connection for residuals of a left kidney condition, status post left nephrectomy, to include as secondary to fibroid tumors, is granted. Entitlement to service connection for residuals of total abdominal hysterectomy and left salpingo oophorectomy, to include as secondary to fibroid tumors, is granted. REMANDED Entitlement to a total disability rating due to individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of mitral valve prolapse. 2. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of endometriosis. 3. The Veteran’s status post small bowel resection, sigmoid colectomy, and maturation of colostomy stoma are related to fibroid tumors and endometriosis that were diagnosed and treated in service. 4. The Veteran’s residuals of a left kidney condition, status post left nephrectomy, are related to fibroid tumors that were diagnosed and treated in service. 5. The Veteran’s residuals of total abdominal hysterectomy and left salpingo oophorectomy are related to fibroid tumors that were diagnosed and treated in service. CONCLUSIONS OF LAW 1. The criteria for service connection for mitral valve prolapse are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a) (2017). 2. The criteria for service connection for endometriosis are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a) (2017). 3. The criteria for entitlement to service connection for residuals of fibroid tumors, also claimed as severe colon tumors, status post small bowel resection, sigmoid colectomy, and maturation of colostomy stoma have been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a) (2017). 4. The criteria for entitlement to service connection for a residuals of a left kidney condition, status post left nephrectomy, to include as secondary to fibroid tumors have been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.310 (2017). 5. The criteria for entitlement to service connection for residuals of total abdominal hysterectomy and left salpingo oophorectomy, to include as secondary to fibroid tumors have been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a) (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the Army from January 1984 to June 1992. Service Treatment Records Not all medical records must be sought, but only those that are relevant to the Veteran’s claim. To conclude that all medical records are relevant would render the word relevant superfluous in the statute governing VA’s duty to assist. Golz v. Shinseki, 590 F.3d 1317 (Fed. Cir. 2010). The relevant records for the purpose of § 5103A are those records that relate to the injury for which the claimant is seeking benefits and have a reasonable possibility of helping to substantiate the Veteran’s claim. VA was unable to obtain service treatment records from 1984 to 1989. The Board finds that these records are irrelevant to each of the claims being denied. The Veteran left active duty in June 1992 and did not file claims for service connection until May and October of 2009. The claims being denied, entitlement to service connection for mitral valve prolapse and endometriosis, are being denied for lack of an active diagnosed condition during the period on appeal. Records from before 1990 do not have a reasonable possibility of helping to substantiate the Veteran’s claim, because they are too far removed from the period on appeal to show whether the Veteran had an active diagnosis during that period. As the remaining claims are being granted, the lack of records is causing no harm to the Veteran. Service Connection 1. Entitlement to service connection for a heart condition, claimed as mitral valve prolapse. The Veteran contends that she has a mitral valve prolapse related to her service or service-connected disabilities. 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 mitral valve prolapse 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) (2012); 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) (2017). The October 2014 VA examiner evaluated the Veteran and determined that, while she experienced subjective symptoms of heart palpitations, chest pain, dyspnea, and fatigue, she did not have a diagnosis of mitral valve prolapse or any other objectively verifiable heart condition. This examination included a chest x-ray, EKG, and ECHO tests. All three objective tests were normal. The only objective abnormality noted was an abnormal heart sounds, specifically a 5/6 holosystolic murmur. The examiner also acknowledged that she had been told in 2005 that she had mitral valve prolapse and was prescribed medication to treat the condition. Based on this examination and a review of the Veteran’s medical records, the examiner opined that the Veteran did not have a mitral valve prolapse. Congestive heart failure was also ruled out. While the Veteran believes she has a current diagnosis of mitral valve prolapse, she is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The Veteran has stated that she was diagnosed with this condition, but provided no competent medical evidence to support this claim or explain the normal results of the October 2014 VA examiner’s testing. Consequently, the Board gives more probative weight to the competent medical evidence, specifically the opinion of the October 2014 VA examiner. Because the preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of mitral valve prolapse, service connection is not warranted for this condition. 2. Entitlement to service connection for endometriosis The Veteran contends that she has endometriosis which began in 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 endometriosis 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). The October 2014 VA examiner evaluated the Veteran and determined that, while she was previously diagnosed with endometriosis, this condition resolved after surgeries performed in July 2002 and March 2005. After examining the Veteran and reviewing her records, the October 2014 VA examiner stated that there was no current pathology on which to base a diagnosis. The Veteran also stated at her May 2018 Board hearing that the symptoms of her fibroids and endometriosis were essentially the same, and had resolved, but not before causing her to have a hysterectomy, oophorectomy, and colorectomy. She stated that her current symptoms are from residuals of these surgeries. Those residuals are addressed in a separate section. Because the preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of endometriosis, service connection is not warranted for this condition. 3. Entitlement to service connection for residuals of fibroid tumors, also claimed as severe colon tumors, status post small bowel resection, sigmoid colectomy, and maturation of colostomy stoma The Veteran contends that she has severe colon tumors, status post small bowel resection, sigmoid colectomy, and maturation of colostomy stoma are residuals of her fibroid tumors which were diagnosed and treated during service. The Board concludes that the Veteran has a current diagnosis of status post small bowel resection, sigmoid colectomy, and maturation of colostomy stoma that are residuals of her fibroid tumors which began in and were treated in 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’s service treatment records (STR) show the Veteran was diagnosed with uterine fibroids in and treated with Lupron in 1990 or 1991. Post-service records show continuing diagnosis and treatment for fibroids in May 1993, and again in 1998. In July 2002, the Veteran underwent a hysterectomy and bilateral oophorectomy to remove recurring symptomatic fibroids. An October 2014 VA examiner described the Veteran’s fibroids as increasing in size and eventually compressing surrounding organs, including the bladder, intestines, and ovaries, eventually necessitating the July 2002 total abdominal hysterectomy and bilateral oophorectomy. The October 2014 examiner opined that fibroids and endometriosis were historical diagnoses without current pathology, and that no military service was related to these conditions. However, this examiner did not provide a supporting rationale or address the issue of residuals of the Veteran’s surgeries. The October 2014 examiner stated that the Veteran’s 2005 small bowel resection, actually two surgeries two weeks apart, were caused by two large tumors obstructing the colon. During the second surgery the Veteran had almost complete colectomy, which resulted in her now wearing a colostomy bag. The October 2014 examiner stated that these colon surgeries were not related to anything gynecological because they were caused by tumors. However, no rationale was provided to show why fibroid tumors could not be the ones causing colon problems and no evidence was provided to show that a different type of tumor was involved. A June 2018 private medical opinion stated that the Veteran’s current condition is a direct result of fibroid tumors and endometriosis diagnosed and treated while on active duty. The examiner cited medical literature that stated fibroids and endometriosis can produce adhesions that can affect and or invade all abdominal and pelvic organs including bowel, bladder, colon, ureters, ovaries, and uterus. The Board finds that the June 2018 private examiner’s opinion is the most probative evidence of record because this examiner provided an opinion that was consistent with the Veteran’s medical history and included citations to supporting medical literature. Because the balance of the evidence shows that the Veteran’s status post small bowl resection with sigmoid colectomy and maturation of colostomy stoma are residuals of the Veteran’s fibroid tumors that began in service, service connection is warranted for this condition. 4. Entitlement to service connection for residuals of total abdominal hysterectomy and left salpingo oophorectomy, to include as secondary to fibroid tumors As described above, the Veteran was diagnosed with fibroid tumors in service and treated in service. However, the treatment did not completely resolve the condition. The Veteran’s fibroids worsened until she had a total abdominal hysterectomy and bilateral oophorectomy in July 2002. While an October 2014 VA examiner did opine that the Veteran’s fibroids were an historical diagnosis with no current pathology, medical records also make it clear that the organs removed have not spontaneously regenerated and any ongoing symptoms status post hysterectomy and bilateral oophorectomy are the result of the Veteran’s fibroid tumors which began in service. Service connection for this condition is therefore warranted secondary to service-connected residuals of fibroid tumors which began in service. 5. Entitlement to service connection for a residuals of a left kidney condition, status post left nephrectomy, to include as secondary to fibroid tumors A June 2005 medical record noted an injury to the Veteran’s left ureter during prior surgery. Decreased renal function was noted and an August 2005 urography with contrast showed left kidney atrophy. An October 2014 VA examiner recorded the Veteran’s medical history including injury to the Veteran’s left ureter during her July 2002 total abdominal hysterectomy and bilateral oophorectomy. This condition progressed until she required a left nephrectomy in 2008. The same examiner later stated that the Veteran’s left renal problem occurred in 2005, three years after her hysterectomy and oophorectomy. The examiner stated that the colonic masses and possibly endometriosis compressed the left ureter, which required stenting between the colon surgeries. The examiner could find no urological surgery notes to confirm this account. While the examiner presented the causal connection to the Veteran’s colon surgery as a rationale showing lack of secondary service connection, the Board has found that the Veteran’s colon surgeries are service-connected. Despite its phrasing, the October 2014 examiner’s opinion shows a causal nexus between the Veteran’s service-connected colon surgeries and her current status post left nephrectomy. If the October 2014 examiner’s first statement is credited, assigning blame for the Veteran’s left ureter injury to her July 2002 hysterectomy and oophorectomy, the outcome is the same, as this was also a service-connected surgery. Secondary service connection is therefore warranted for the Veteran’s status post left nephrectomy. REASONS FOR REMAND 1. Entitlement to a total disability rating due to individual unemployability (TDIU) is remanded. The Board has granted service connection for residuals of fibroid tumors, status post hysterectomy and bilateral oophorectomy, status post small bowel resection, and status post left nephrectomy. Once these are assigned disability ratings, the Veteran must be evaluated for her claim of individual unemployability with her newly rated service connected conditions taken into account. The matter is REMANDED for the following action: 1. Ask the Veteran to complete a TDIU claim form. Then, schedule the Veteran for an examination by an appropriate clinician regarding the current severity of her service-connected disabilities. The examiner should elicit from the Veteran her complete educational, vocational, and employment history and should note her complaints regarding the impact of her service-connected disabilities on employment. The examiner should identify all limitations or functional impairment caused solely by her service-connected disabilities. 2. Readjudicate the Veteran’s claim for a TDIU. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Zimmerman, Associate Counsel