Citation Nr: 20022010 Decision Date: 03/30/20 Archive Date: 03/30/20 DOCKET NO. 19-25 988A DATE: March 30, 2020 REMANDED Entitlement to service connection for residuals of hysterectomy is remanded. Entitlement to an initial disability rating in excess of 30 percent for posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from January 2003 to January 2005, and from February 2008 to March 2009, to include service in the Southwest Asia theater of operations during the Persian Gulf War. See 38 C.F.R. §§ 3.2(i), 3.317(e); DD Form 214 (noting service in Kuwait/Iraq from April 2008 to January 2009). She also had periods of service in the U.S. Army Reserve through August 2012. These matters come to the Board of Veterans’ Appeals (Board) on appeal from August 2017 and May 2018 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office. The August 2017 decision granted service connection and a 30 percent rating for PTSD, effective May 28, 2013. The May 2018 decision denied service connection for residuals of hysterectomy. The Veteran submitted a Rapid Appeals Modernization Program (RAMP) Opt-In Election form in February 2018, which was initially acknowledged by the agency of original jurisdiction (AOJ) in June 2018. However, there was no pending appeal at the time of her February 2018 RAMP election. Therefore, the AOJ sent a clarifying letter in September 2018 notifying the Veteran that “you do not have an appeal pending that qualifies for processing under RAMP.” See September 2018 notice letter (explaining that the “issue identified involves the April 20, 2015 Notice of Disagreement for the issue of acquired psychiatric disorder (claimed as depression and harassment). The [] decision dated August 31, 2017 granted service connection for [PTSD] which constitutes a full grant of benefits for the mental health condition.”). Therefore, the February 2018 RAMP election is invalid. That said, in August 2018, the Veteran submitted a timely legacy notice of disagreement with respect to the initial rating assigned for PTSD. See VA Form 21-0958 (disagreeing with the “[e]valuation of [d]isability” for her PTSD). The Board takes limited jurisdiction over that issue for the purpose of remanding it for issuance of a statement of the case. Manlincon v. West, 12 Vet. App. 238, 240-41 (1999). 1. Entitlement to service connection for residuals of hysterectomy is remanded. With respect to the Veteran’s claim of entitlement to service connection for residuals of hysterectomy, a remand is required for additional development. First, the Veteran provided a release for VA to obtain records of private treatment from Dr. M. of Erlanger Medical Hospital. However, the AOJ was informed by the Erlander Health System in January 2018 that the “hospital does not maintain physician office records. Any request for the physician’s office records should be sent directly to the physician.” The AOJ thereafter made a second attempt to request the records from Erlander Health System. However, it did not advise the Veteran of the hospital’s response to the effect that Dr. M. should be contacted directly. A remand is necessary to allow the Veteran an opportunity to provide an appropriate release for the records from Dr. M., and identify any other private care providers, such as her primary care provider, Dr. C., or her gynecologist, Dr. R., referred to in a November 2013 VA treatment report, who may have potentially outstanding and relevant treatment records. While the case is in remand status, any outstanding VA treatment records should also be obtained and associated with the claims file. A remand is also needed in order to afford the Veteran an adequate VA examination and medical opinion. The Board notes that the Veteran has provided information about experiencing recurring ovarian cysts, and that service connection for such cysts was previously adjudicated and denied in June 2014 and February 2015 rating decisions that were issued prior to the subsequent obtainment of her service treatment records by VA in July 2017. Notwithstanding the fact that she underwent a VA gynecological examination in February 2015 in conjunction with her prior claim for ovarian cysts, the record does not contain sufficient medical evidence upon which to make a determination as to her current claim for service connection for residuals of hysterectomy. See service treatment records obtained July 2017; and compare February 2015 VA examination report (noting that the Veteran did not have a hysterectomy or a history of endometriosis) with VA treatment records (assessing and noting the Veteran’s history of endometriosis) and her December 2017 claim for hysterectomy residuals. Here, there are in-service complaints of gynecological symptoms such as abnormal vaginal bleeding, pelvic pains, ovarian cysts, and a noted history of endometriosis. See, e.g., April 2003, July 2003, November 2003, July 2004, August 2004, February 2008, and September 2008 service treatment records. A VA examination and opinion are warranted to determine the nature and etiology of any current hysterectomy residuals. See 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). Moreover, in a February 2014 VA treatment report, the Veteran discussed a connection between her service-connected pituitary tumor and subsequent inability to have biological children, recurrent ovarian cysts, and endometriosis. This potentially raises the theory of entitlement to service connection residuals of a hysterectomy on a secondary basis, and, therefore, the Board requests the examiner also assess whether the Veteran may have any current residuals of a hysterectomy that are secondary to her service-connected benign hyperpituitarism. 2. Entitlement to an initial disability rating in excess of 30 percent for PTSD is remanded. With respect to the issue of entitlement to an initial disability rating in excess of 30 percent for PTSD, the Veteran submitted a timely notice of disagreement on a VA Form 21-0958 with an August 2018 rating decision that awarded service connection. See August 2019 VA Form 21-0958. A remand is required for issuance of a statement of the case. Manlincon, supra. These matters are REMANDED for the following action: 1. Unless the matter is resolved by granting in full the benefits sought, or the notice of disagreement is withdrawn, send the Veteran and her representative a statement of the case that addresses the issue of entitlement to an initial disability rating in excess of 30 percent for PTSD. If the Veteran perfects an appeal by submitting a timely substantive appeal, the issue should be returned to the Board for further appellate consideration. 2. Obtain the Veteran’s VA treatment records for the period from August 2017 to the present. 3. Ask the Veteran to complete a VA Form 21-4142 for any outstanding private treatment records, including but not limited to, records from Dr. M. directly (as opposed to the Erlander Medical hospital, per the January 2018 response from Erlander Health System), as well as from Dr. C., her prior primary care provider, and Dr. R., her gynecologist, referred to in November 2013 VA treatment report. Make two requests for the authorized records from any identified private treatment providers unless it is clear after the first request that a second request would be futile. 4. After the foregoing development has been completed to the extent possible, arrange to have the appellant scheduled for a VA gynecological examination. The examiner should review the record. All indicated tests should be conducted and the results reported. After examining the Veteran and reviewing the record, together with the results of any testing deemed necessary, the examiner should offer an opinion as to (1) whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that the Veteran has current residuals of a hysterectomy related to any period of active service, including the reported gynecological symptoms and complaints noted in April 2003, July 2003, November 2003, July 2004, August 2004, February 2008, and September 2008 service treatment records, and (2) whether it is at least as likely as not that she has residuals of a hysterectomy that have been either caused OR aggravated (i.e., worsened beyond natural progression) by her service-connected benign hyperpituitarism. A complete medical rationale for all opinions expressed must be provided. 5. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the issue of entitlement to service connection for residuals of a hysterectomy should be readjudicated based on the entirety of the evidence. If the benefit sought remains denied, the   Veteran and her representative should be issued a supplemental statement of the case. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Gielow, 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.