Citation Nr: 20005308 Decision Date: 01/23/20 Archive Date: 01/22/20 DOCKET NO. 17-56 005 DATE: January 23, 2020 ORDER Entitlement to service connection for residuals of ovarian cancer, status post total abdominal hysterectomy, salpingo-oophorectomy, is granted. FINDING OF FACT The Veteran’s ovarian cancer onset during service. CONCLUSION OF LAW The criteria for service connection for residuals of ovarian cancer, status post total abdominal hysterectomy, salpingo-oopherectomy, have not been satisfied. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1981 to December 1983. This matter comes before the Board of Veterans’ Appeals (Board) from a September 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared at Travel Board hearing before the undersigned Veterans Law judge in October 2019. A transcript of the hearing is of record. Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called “nexus” requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). VA has established certain rules and presumptions for chronic diseases, such as malignant tumors. See 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). With chronic diseases shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless attributable to intercurrent causes. 38 C.F.R. § 3.303(b). If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. § 3.303(b). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). The record reflects that, after suffering severe abdominal pain, the Veteran underwent surgery in November 1987 for the removal of a right ovarian tumor, diagnosed as a grade II immature teratoma. She asserts that this tumor had its onset during her active service (noting in-service complaints of abdominal pain, weight change, and an abnormal menstrual cycle) and that the resultant chemotherapy and additional surgeries have resulted in residual conditions including a hysterectomy, a pelvic cyst, nerve damage, infertility, kidney problems, ulcerative colitis, fatigue, fibromyalgia, and an acquired psychiatric disorder. The Board notes that her service treatment records (STRs) do note such sick call visits, with June 1981 and March 1982 records noting an evaluation for menstrual irregularity and a July 1982 evaluation for amenorrhea. An August 1983 complaint of lower right quadrant pain was assessed as a pulled muscle, with no diagnostic testing performed. Her separation report of medical history notes treatment for a “female disorder” and a change in menstrual pattern. Physical examination at separation was normal; however, the Board notes that there is no indication that diagnostic testing was performed of the Veteran’s pelvic area. The Veteran argues that her symptoms during service were dismissed at the time as either premenstrual syndrome or a muscle strain (as well as an accusation that she was malingering), but were instead the early onset of her ovarian cancer and provided medical research evidence that suggest that the early symptoms of immature teratomas can include her in-service complaints. A VA examiner’s opinion was obtained in August 2016; however, a negative etiological opinion was provided. The examiner explained that review of current medical literature revealed that, while clinical presentation of immature teratoma may include abdominal enlargement, “a history of change in menstrual pattern and amenorrhea are not identified as clinical manifestation of the condition of immature teratoma of the ovary” at the time of her later diagnosis. As previously noted, however, the Veteran has submitted her own research that suggests that her in-service symptoms of abdominal pain and an irregular menstrual patter can, in fact, be suggestive or early-onset ovarian tumors. The Board also notes that the VA examiner only noted the Veteran’s in-service menstrual issues in the rationale and made no mention of her lower right quadrant abdominal pain. Thus, while probative, this opinion is of limited probative weight. The Veteran has submitted positive nexus opinions from her treating VA physician, Dr. S.K., in September 2014 and October 2019. In explaining the reasoning behind the positive opinions, Dr. S.K. found it significant that the Veteran had complaints of pelvic pain during service with no diagnostic testing, the tumor was discovered approximately 4 years after service, and the type of tumor the Veteran had is very slow growing. Resolving reasonable doubt in the Veteran’s favor, the Board finds that the Veteran’s ovarian cancer was present during service. As such, service connection for residuals of ovarian cancer, status post total abdominal hysterectomy, salpingo-oophorectomy, is granted. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Scarduzio, 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.