Citation Nr: 19122452 Decision Date: 03/26/19 Archive Date: 03/25/19 DOCKET NO. 17-62 837 DATE: March 26, 2019 REMANDED Entitlement to service connection for status post hysterectomy is remanded. Entitlement to service connection for uterine fibrosis is remanded. Entitlement to service connection for endometriosis is remanded. Entitlement to service connection for female sexual arousal disorder (FSAD), to include as secondary to a gynecological condition and/or service-connected major depression with unspecified anxiety is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1992 to August 1997. These matters come to the Board of Veterans’ Appeals (Board) on appeal from a January 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In June 2018, the Veteran testified at a hearing before the undersigned Veterans Law Judge; a transcript is associated with the claims folder. In a letter received in September 2018, the Veteran revoked power of attorney for The American Legion. Hence, she is considered unrepresented. 1. Service connection for status post hysterectomy is remanded. 2. Service connection for uterine fibrosis is remanded. 3. Service connection for endometriosis is remanded. The Veteran asserts that she has gynecological conditions that onset in or are related to service. The Veteran reports that she did not have any gynecologic problems prior to service. She has testified that she experienced chronic pelvic pain, heavy bleeding and prolonged menses following a loop electrosurgical excision procedure (LEEP) procedure in December 1995. She has also testified that after service, she had an ectopic pregnancy in 1998, then was without a period for at least a year. Further, after the birth of her son in 1999, she continued to have heavy, irregular periods. The evidence of record shows that the Veteran had numerous gynecological complaints, abnormal test results, and procedures in service. During that time, the Veteran was diagnosed with yeast infections, atypical squamous cell of undetermined significance, low-grade squamous intraepithelial lesion, high-grade squamous intraepithelial lesion with HPV characteristics, dysplasia, and chronic cervictitis with squamous metaplasia. Post-service diagnoses include uterine fibroids, pelvic adhesive disease, vaginitis, endometriosis, She is also status post oopharectomy and status post hysterectomy. The Board cannot make a fully-informed decision on the issues because no VA examiner has adequately opined on the etiology of the Veteran’s gynecological conditions. Medical nexus opinions obtained in October 2016 are inadequate because the examiner failed to adequately consider the Veteran’s contentions and reported symptoms; and offer a cogent rationale. For example, part of the examiner’s rationale for the unfavorable opinions was that the Veteran only had one instance of heavy bleeding in service. The Veteran, however, has testified that she frequently experienced heaving bleeding and irregular periods although she did not always seek treatment or report these symptoms when they occurred. The Board finds her credible in this regard. As such, a new VA examination and opinion is required. 4. Service connection for female sexual arousal disorder (FSAD) is remanded. The Veteran seeks service connection for FSAD. She asserts this condition may be related to her gynecologic difficulties during and after service, to specifically include the disabilities claimed on appeal. She also believes it may be secondary to her service-connected disability of major depression with unspecified anxiety disorder, including medication used to treat this. See September 2018 VA Form 21-4138. The Board cannot make a fully-informed decision on this issue because no VA examiner has adequately opined as to whether this disorder onset in service or is related to service; or whether it is secondary to her service-connected depression with unspecified anxiety. Finally, because a decision on the remanded claims could significantly impact a decision on the issue of service connection for FSAD, the issues are inextricably intertwined. A remand of the claims for FSAD is required. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from May 2017 to the present. 2. Schedule the Veteran for an examination to determine the nature and etiology of her currently diagnosed gynecological conditions with a gynecologist, or another appropriate clinician. The examiner should review the claims file and a copy of this remand. The examiner must opine as to whether any currently diagnosed gynecological conditions (to include uterine fibroids, pelvic adhesive disease, vaginitis, endometriosis, status post oophorectomy and status post hysterectomy) are at least as likely as not related to an in-service injury, event, or disease, including (but not limited to) symptoms of pelvic pain, heavy bleeding, and irregular periods, abnormal PAPs and related treatment. A fully-explained rationale for the requested opinions should be provided and the examiner should address the significance, if any, of the in-service clinical findings/treatment and reported symptoms. The examiner’s attention is also directed to the Veteran’s post-service lay assertions, including her June 2018 hearing testimony. If the examiner feels that the requested opinions cannot be rendered without resorting to speculation, he or she must explain why this is so. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of her FSAD. The examiner should review the claims file and a copy of this remand. a) The examiner must opine as to whether FSAD is at least as likely as not related to an in-service injury, event, or disease, including any complaints and/or treatment related to gynecological conditions in service. b) The examiner must also opine as to whether FSAD is at least as likely as not (1) proximately due to service-connected major depression with unspecified anxiety disorder, or (2) aggravated beyond its natural progression by with major depression unspecified anxiety disorder, to include medication used to treat this condition. For all examinations, the examiner is directed that the Veteran is a competent historian and should specifically address her lay testimony concerning onset, history of treatment, and symptomatology. The examiner’s attention is directed to the June 2018 hearing testimony for relevant lay history and assertions. If the Veteran’s assertions are not found to be credible, the examiner must explain why they are not. A fully-explained rationale for the requested opinions should be provided. If the examiner feels that the requested opinions cannot be rendered without resorting to speculation, he or she must explain why this is so. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Vuong, Associate Counsel