Citation Nr: 20000084 Decision Date: 01/02/20 Archive Date: 01/02/20 DOCKET NO. 17-22 395 DATE: January 2, 2020 ORDER Entitlement to service connection for a hysterectomy secondary to a service-connected left ovarian cyst on a causation basis is granted. FINDING OF FACT The evidence is at least evenly balanced as to whether the Veteran’s service-connected left ovarian cyst caused her hysterectomy. CONCLUSION OF LAW Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for a hysterectomy on a secondary, causation basis have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 2002 to June 2006. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a March 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida which denied service connection for hysterectomy secondary to a left ovarian cyst. In April 2015 the Veteran filed her notice of disagreement, was issued a statement of the case in April 2017, and in May 2017 perfected her appeal to the Board. The Veteran testified at a videoconference Board hearing before the undersigned Veterans Law Judge on December 20, 2019. A transcript of the hearing has not yet been associated with the claims file but is not necessary for a decision on the claim. SERVICE CONNECTION Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Service connection is also warranted for disability proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). August 2013 private post-service treatment records note a total laparoscopic hysterectomy and diagnostic cystoscopy. A March 2015 VA examination report noted that the Veteran stated that she has been experiencing hot flashes, night sweats, vaginal dryness, and itching since her hysterectomy for an ovarian cyst and endometriosis in 2013. The examiner opined that the Veteran’s laparoscope assisted hysterectomy was not caused by any diagnosed condition during active duty. The examiner noted that the Veteran’s service treatment records show that she had been complaining of pelvic pain and that she was given medication to alleviate the pain during service. The Veteran reported a history of endometriosis and ovarian cyst as the reason for her hysterectomy, but there is no endometriosis, no record she was diagnosed as having an ovarian cyst during active duty, and the Veteran was diagnosed as having a right and left ovarian cyst during her 2009 and 2014 procedures. In a December 2018 letter, the Veteran’s private physician noted that she has been treating the Veteran since August 2007 and that the Veteran has a diagnosis of total laparoscopic hysterectomy. She noted the Veteran’s diagnosis of left side ovarian cyst in October 2012, her surgery for severe endometriosis, chronic pelvic pain, and pelvis peritoneum, and stated that the left pelvic pain and left ovarian cyst were more than likely the primary reason for the total laparoscopic hysterectomy. The physician stated that the Veteran had no other known risk factors that may have precipitated her current condition and opined that it was more likely than not that the Veteran’s condition was not responding to the medical management and for this reason the hysterectomy was medically necessary. The evidence is at least evenly balanced as to whether the Veteran’s hysterectomy was caused by her service-connected left ovarian cyst. While the March 2015 examiner opined that the Veteran’s hysterectomy was not caused by any diagnosed condition during active duty, the March 2015 examiner failed to consider the Veteran’s complaints of pelvic pain during service, relying primarily on the fact that there were no diagnoses of ovarian cysts until several years after service which is impermissible. Therefore, the March 2015 examination report is afforded little probative value. The Veteran’s private physician opined that her left pelvic pain and service-connected left ovarian cyst were more than likely the primary reason for the hysterectomy. The private physician provided a thorough rationale to support her opinion and her opinion is therefore afforded significant probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for a hysterectomy is warranted on a secondary, causation basis. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Maddox, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.