Citation Nr: 18159952 Decision Date: 12/21/18 Archive Date: 12/20/18 DOCKET NO. 17-36 621 DATE: December 21, 2018 ORDER Entitlement to service connection for a pelvic disorder, including cervicitis, is denied. Entitlement to service connection for an acquired psychological disorder, to include depression and anxiety, is denied. REMANDED Entitlement to an increased initial rating for residuals of a urinary tract infection with bladder incontinence is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has a chronic pelvic disorder, to include cervicitis, that is related to service, or that is caused or worsened by a service connected disorder. 2. The preponderance of the evidence is against finding that an acquired psychiatric disability, to include depression and anxiety, is related to service, and against finding that a psychosis was compensably disabling within a year of separation from active duty. CONCLUSIONS OF LAW 1. A chronic pelvic disorder to include cervicitis was not incurred or aggravated inservice, and it is not caused or aggravated by a service connected disability. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. An acquired psychiatric disability, to include depression and anxiety, was not incurred or aggravated inservice, a psychosis may not be presumed to have been so incurred, and an acquired psychiatric disorder was caused and is not aggravated by a service connected disorder. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1981 to June 1998. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Augusta, Maine. With respect to the Veteran’s claim herein, VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred or aggravated in active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Generally, establishing service connection requires (1) evidence of a current disability; (2) medical, or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Pelvic disorder to include cervicitis. The Veteran contends that she has a pelvic disorder, to include cervicitis, that is secondary to complications resulting from an intrauterine device that was implanted during 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. After reviewing the evidence of record the Board finds that the Veteran does not have a current diagnosis of a chronic pelvic disorder to include cervicitis, and has not had such a disorder at any time during the pendency of the claim or recent to the filing of the claim. As such, there is no basis to grant service connection. 38 U.S.C. §§ 1110, 1131; Brammer v. Derwinski, 3 Vet. App 223 (1992) (In the absence of a disability there can be no valid claim.) In this regard, a review of the service treatment records shows that at enlistment the appellant was using an intrauterine device. In June 1982 the appellant had a Copper 7 intrauterine device removed. It was noted to have been inserted three years prior, and that the claimant began having pain two days prior to removal. A new intrauterine device was implanted later that year which was removed in 1988. A March 1998 retirement examination did not yield any diagnosis of a chronic pelvic disorder to include cervicitis. In January 2016 the appellant was seen for a VA examination following which the examiner determined that while she experienced subjective symptoms of incontinence and occasional urinary tract infection, she did not have a diagnosis of cervicitis, or any other pelvic disease. The examiner stated that the Veteran’s in-service cervicitis resolved and there were no current symptoms. He explained that the cervicitis resolved when the intrauterine device was removed in service. The examiner also stated that there was no evidence showing any other chronic pelvic disease, and there was no current diagnosis of any pelvic disease, including cervicitis. While the file reflects treatment for various disorders between June 2000 and December 2015, these VA treatment records do not contain a diagnosis of cervicitis or any other chronic pelvic disease. While the Veteran believes she has a current diagnosis of cervicitis, she is not competent to provide a diagnosis in this case. The diagnosis of a gynecological disorder and any relationship between such a disorder issue is medically complex, as it requires specialized medical education. Jandreau, 492 F.3d at 1377 n. Consequently, the Board gives more probative weight to the competent medical evidence. Since the Veteran has no current diagnosis of cervicitis, or any pelvic disorder, entitlement to service connection is denied. Brammer. An acquired psychiatric disability The Veteran contends that she experiences depression and anxiety secondarily due to complications resulting from her service connected history of urinary tract infections with bladder incontinence. 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. In this regard the evidence shows that the Veteran does not have a current diagnosis of any acquired psychiatric disability to include depression and anxiety, and she has not had one at any time during the pendency of the claim or recent to the filing of the claim. Hence, the claim must be denied. 38 U.S.C. §§ 1110, 1131; Brammer. At the Veteran’s March 1998 separation examination, she reported a history of depression or excessive worry. It was noted that she had seen a counselor between October 1997 to January 1998. Her service treatment records are, however, silent for any complaints, treatment or diagnosis of an acquired psychiatric disability. Clinical evaluation at her retirement examination revealed that the appellant was psychiatrically normal. Further, despite subsequent treatment at VA facilities for other disorders, VA treatment records do not contain a diagnosis of an acquired psychiatric disorder to include depression or anxiety. In fact, records from Fayetteville VA Medical Center contain multiple negative depression screens with the Veteran’s denial of depression and anxiety. While the Veteran believes she has a current diagnosis of depression and anxiety disorder, she is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau. Consequently, the Board assigns greater probative weight to the competent medical evidence. In the absence of a disability there can be no valid claim. Brammer. In addition, although there are mentions of counseling during the claim period, the Board finds that the record preponderates against finding of a disability present at any point during the claim period or shortly before. Service connection is therefore denied. REASONS FOR REMAND The Veteran asserts that her urinary tract infection residuals with bladder incontinence have increased in severity and that her current noncompensable rating does not adequately reflect the severity of her current condition. In January 2016 the Veteran’s rating was assigned a non-compensable rating. The Veteran was afforded a VA examination in January 2016 at which time the examiner noted that the claimant’s voiding dysfunction was idiopathic in nature and caused urine leakage, but did not require the wearing of absorbent material. The Veteran disagreed with the rating assigned and noted in her notice of disagreement that she had to get up 4-6 times a night to urinate, and that she was experiencing urinary incontinence when she coughed, sneezed, or laughed. She also reported wearing Depends or panty liner pads depending on the day. In her substantive appeal the Veteran noted that her urinary incontinence had worsened to the point where she was going to the bathroom several times an hour, and that incontinence had become worse and persistent. She noted ordering liners from VA. Based on these statements from the Veteran, the Board finds that remand for an examination is necessary. Green v. Derwinski, 1 Vet. App. 121, 124 (1991) (VA’s statutory duty to assist includes a thorough and contemporaneous medical examination). The Board also notes that the Veteran’s VA treatment records have not been updated since May 2016. On remand, any outstanding VA treatment notes should be associated with the VBMS and Virtual VA/Legacy files and updated records should continually be associated with the claims file until it returns to the Board. The Veteran should be also asked to identify any private treatment for any of the claims being remanded. The RO should attempt to obtain any records identified and associate them with the claims file. The matter is REMANDED for the following action: 1. Associate with the claims folder all pertinent, outstanding private and VA records pertaining to treatment for residuals of a urinary tract infection with bladder incontinence. If the RO cannot locate such records, it must specifically document the attempts that were made to locate them, and explain in writing why further attempts to locate or obtain any government records would be futile. The RO must then: (a) notify the claimant of the specific records that it is unable to obtain; (b) explain the efforts VA has made to obtain that evidence; and (c) describe any further action it will take with respect to the claims. The claimant must then be given an opportunity to respond. 2. Thereafter, schedule the Veteran for a new VA examination to assess the current severity of any residuals of a urinary tract infection with bladder incontinence. The Veteran’s VBMS and Virtual VA/Legacy files must be reviewed by the examiner in conjunction with the examination, to include Veteran statements. The examiner is to specifically describe the severity of any associated urinary frequency, or incontinence. The examiner is to discuss whether the Veteran uses incontinence pads and the frequency that those pads are changed. A complete, well-reasoned rationale must be provided for any opinion offered. If any requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the   examiner does not have the needed knowledge or training. DEREK R. BROWN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Joseph Montanye, Associate Counsel