Citation Nr: 18157421 Decision Date: 12/12/18 Archive Date: 12/12/18 DOCKET NO. 16-42 865 DATE: December 12, 2018 REMANDED Entitlement to a gynecological disability, to include condyloma and partial hysterectomy residuals, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1986 to August 1992. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. Jurisdiction is currently in the RO in Newark, New Jersey. Entitlement to a gynecological disability, to include partial hysterectomy residuals and condyloma, is remanded. The Veteran contends that she has a gynecological disability, to include condyloma and partial hysterectomy residuals, due to in-service treatments and diagnoses pertinent to condyloma. See December 2018 Appellant’s Brief. Service treatment records document various treatment notes for condyloma. See, e.g., January and February 1988 service treatment notes (containing diagnoses for condyloma accuminata); March 1988 service treatment note (containing an assessment of recurrent condyloma); February 1989 service treatment note (noting a history of genital condyloma and the possibility that such is related to the Veteran’s report of lumps in her throat). Post service clinical records indicate that the Veteran underwent a partial hysterectomy in July 2002. See January 2003 clinical record from Tyndall Air Force Base. In November 2013 and January 2014 opinions, the VA examiner diagnosed partial hysterectomy and opined that “there is insufficient evidence to support partial hysterectomy as secondary to condyloma” and that “as per medical literature, Condyloma . . . is not an indication for hysterectomy,” see January 2014 VA opinion. In doing so, the examiner failed to provide citation for the refenced medical literature or a clear rationale for his opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Further, in an August 2016 statement, Dr. M.U.T. wrote that the Veteran was “diagnosed with condyloma/HPV” and remarked that “the HPV is primarily responsible for abnormal pap smears for cervical cancer and ultimate treatment is a hysterectomy,” but the private physician provided no explanation for her statement. See Nieves-Rodriguez, 22 Vet. App. at 304; Obert v. Brown, 5 Vet. App. 30, 33 (1993). A remand is necessary for a VA examination for an opinion addressing these deficiencies. Additionally, the Veteran’s separation examination report is not associated with the claims file. On remand, the AOJ should obtain the missing report. See 38 C.F.R. § 3.159(c). The matter is REMANDED for the following action: 1. Obtain the Veteran’s separation examination report for her service from August 1986 to August 1992. All reasonable attempts should be made to obtain such record. If such record cannot be obtained after reasonable efforts have been made, issue a formal determination that such record does not exist or that further efforts to obtain such record would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such record, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Update private and VA clinical records of the Veteran. 3. Schedule the Veteran for an appropriate VA examination to address her claimed gynecological disability. All indicated tests and studies should be undertaken. (A) The examiner should identify all current diagnoses related to the claimed gynecological disability since the date of claim (i.e. since February 2013), even if such diagnosis is currently asymptomatic or resolved during the pendency of the appeal. (B) For each diagnosis, the examiner should opine whether it is at least as likely as not (i.e. a 50 percent or greater probability) that such disability had its onset or is otherwise medically related to service, to include as due to various in-service treatments and diagnoses for condyloma. See, e.g., January, February, and March 1988 service treatment notes; February 1989 service treatment note. In rendering the requested opinion, the examiner should address the August 2016 statement from Dr. M.U.T., who found that “HPV is primarily responsible for abnormal pap smears for cervical cancer and ultimate treatment is a hysterectomy.” The Veteran has alleged that the condition was diagnosed while she was on active duty and that is was linked to HPV which ultimately resulted in hysterectomy. (See form 9 dated September 1, 2016.) A complete rationale should be given for all opinions and conclusions expressed. 4. After completing the above, and any other development as may be indicated, the AOJ is to readjudicate the claim based on the entirety of the evidence of record. If the claim remains denied, the Veteran and her representative should be issued a supplemental statement of the case. An appropriate period should be allowed for response. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Kim, Associate Counsel