Citation Nr: 20028343 Decision Date: 04/22/20 Archive Date: 04/22/20 DOCKET NO. 16-07 074 DATE: April 22, 2020 ORDER Entitlement to service connection for residuals of a hysterectomy is denied. FINDING OF FACT At no time during the relevant appeal period did a causal relationship exist between the Veteran’s hysterectomy and her active duty service. CONCLUSION OF LAW The criteria for entitlement to service connection for residuals of a hysterectomy have not been met. 38 U.S.C. §§ 1131, 1154, 5107; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from June 1979 to January 1986. This appeal comes to the Board of Veterans’ Appeals (Board) from a rating decision, dated May 2014, issued by a Department of Veterans Affairs (VA) Regional Office (RO). In its decision, the RO denied service connection for a hysterectomy because the condition neither occurred in nor was caused by service. The Veteran timely appealed. The Veteran’s appeal has previously been before the Board. In September 2018, the Board remanded this matter to the AOJ for additional development. Service Connection In seeking VA disability compensation, a Veteran generally seeks to establish that a current disability results from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131. “Service connection” basically means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 C.F.R. § 3.303. Establishing service connection generally requires competent evidence showing: (1) the existence of a current disability; (2) 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. Shedden v. Principi, 381, F.3d 1163, 1167 (Fed. Cir. 2004). 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). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. Entitlement to service connection for a hysterectomy The Veteran claims entitlement to service connection for a hysterectomy. Following a thorough review of the Veteran’s medical records, the Board finds that she is not entitled to an award of service connection. A review of the Veteran’s December 2013 VA examination shows the Veteran had a hysterectomy in 1999, and a current diagnosis of status post vaginal hysterectomy. Her current symptoms were abdominal pain and stress incontinence, but she was not being treated for any related symptoms. Therefore, the Board finds that the Veteran has satisfied the first prong of service connection, the existence of a current disability. 38 U.S.C. § 1131; Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). As to evidence of an in-service incurrence or aggravation of a disease or injury, the Veteran reported that while in service she was told by a doctor in Germany that she needed to have a hysterectomy due to irregular monthly menstrual cycles. See Notice of Disagreement dated June 2015. She reported being diagnosed with uterine fibroids and menorrhagia approximately between 1981 and 1983. See VA Examination dated December 2013. The Veteran reported that her period would come in the middle of her menstrual cycle, even when she was on birth control. She would have heavy bleeding and blood clots during her periods. She eventually went to the doctor and was diagnosed with uterine fibroids and menorrhagia. Years later, she underwent a total hysterectomy and bilateral oophorectomy. The Veteran’s service treatment records (STRs) show that in September 1979, the Veteran had intermenstrual bleeding and vaginal discharge. STRs from January 1980, March and May 1980, May 1985, and November 1985 showed that the Veteran reported menstrual cramps several times a day as well as diarrhea. She also experienced uterine cramps in June 1980 and menorrhagia in January 1983. Therefore, the Board finds that the Veteran has satisfied the second prong of service connection, evidence of an in-service gynecological disease or injury. 38 U.S.C. § 1131; Boyer, 210 F.3d at 1353. Turning next to evidence of a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the Board finds the weight of the medical evidence does not support a nexus. In reaching this determination, the Board finds the medical opinion of the July 2019 VA examiner to be probative and entitled to significant weight. VA treatment records first document leiomyoma of uterus (uterine fibroids) in November 1998, where the Veteran was diagnosed with excessive or frequent menstruation and leiomyoma of uterus. A biopsy of the uterus lining was ordered. In January 1999, VA treatment records stated that the medical condition of leiomyoma of uterus necessitates surgery, specifically a total vaginal hysterectomy. The Veteran had her first VA examination in December 2013 in which she was diagnosed with a status post vaginal hysterectomy. After a thorough review of the Veteran’s STRs and medical records, the VA examiner concluded that the Veteran’s hysterectomy was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. This opinion was based on the fact that there was no physical or radiological evidence that the Veteran had a hysterectomy condition in service. A review of the Veteran’s medical records showed no record of a diagnosis for a hysterectomy condition during her service period. Therefore, the claimed condition was less likely than not proximately due to or the result of the Veteran’s service-connected condition. Following the September 2018 BVA decision, the Board remanded the Veteran’s service connection claim for a hysterectomy because the Veteran indicated that VA treatment records necessary to decide her claim had not been procured. Therefore, the Board requested the Veteran undergo another VA medical examination. The VA treatment records identified by the Veteran have been associated with the record. During a July 2019 VA examination, a VA examiner documented a hysterectomy secondary to fibroids that was completed in 1999. The examiner reviewed the STRs and post-service medical records and stated that there is no evidence in the Veteran’s STRs that she suffered from fibroids during active duty. Because VA treatment records documented a hysterectomy was done in 1999 secondary to fibroids, the VA examiner concluded that it was less likely than not that the Veteran suffered from fibroids causing menorrhagia for 13 years before having a hysterectomy. He found no evidence in her file to support that she suffered with fibroids during active duty service, after separation and continuing until her hysterectomy in 1999. Although the Veteran is competent to report symptoms and experiences that are observable to an ordinary person, there is no indication that she has the medical qualifications or experience necessary to offer an expert opinion on a matter of whether she had fibroids in service or whether her gynecological symptoms in service caused her hysterectomy 13 years later. Layno v. Brown, 6 Vet. App. 465, 470 (1994); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007). The probability that a relationship exists between her hysterectomy and her service is a matter of medical complexity and not the proper subject of lay testimony. The Board finds the VA examiners’ medical opinions provide clear and well-reasoned explanations with supporting data, and reasoned medical explanations connecting the two. Accordingly, the Board places greater probative value on the opinions reached by the VA examiners. As described above, the Veteran’s lay evidence is that she had symptoms of menorrhagia in service as well as irregular monthly menstrual cycles, and that she was diagnosed with fibroids in service. The Veteran is competent to report experiencing these symptoms and being told she had fibroids. However, the STRs do not show a diagnosis of uterine fibroids in service as reported by the Veteran, and there is only one diagnosis of menorrhagia. In September 1985, a report of medical examination documented a normal pelvic exam in October 1984 with normal pap smear. The Veteran’s medical records did not show any reports of uterine fibroids until years following her separation from active duty service. The Board has considered the Veteran’s statements that she experienced symptoms such as irregular monthly menstrual cycles and heavy bleeding. The Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Here, the Board is not basing its conclusions solely on the lack of fibroids or a hysterectomy being performed while the Veteran was in service, but by viewing it in the context of the entire record. The absence of evidence cannot be substantive negative evidence without a proper foundation to demonstrate that such silence has a tendency to prove or disprove a relevant fact. Fountain v. McDonald, 27 Vet. App. 258, 272 (2015) (“The absence of an entry in a record may be evidence against the existence of a fact if such a fact would ordinarily be recorded.”). Here, the STRs show numerous incidents of the Veteran being seen for gynecological symptoms and other ailments. However, fibroids are not diagnosed or documented. Given this context, the Board finds that if fibroids had been diagnosed in service, it would have been documented in the STRs alongside the other gynecological diagnoses. While the Veteran may sincerely believe she was diagnosed with fibroids or had them in service, the Board finds the contemporaneous treatment records to be more probative and finds the preponderance of the evidence does not show fibroids in service. As made clear by the July 2019 VA examiner, while the Veteran had a hysterectomy secondary to fibroids, fibroids did not occur until many years following her active duty service. Without any evidence of uterine fibroids, which led to the Veteran’s hysterectomy in 1999, 13 years after separation from service, the Board finds the weight of the probative evidence of record is against a finding of a causal relationship between the Veteran’s status post hysterectomy and service. Although the Veteran is entitled to the benefit of the doubt where the evidence is in approximate balance, the benefit of the doubt doctrine is inapplicable where, as here, the preponderance of the evidence is against the claim for service connection. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. LAURA E. COLLINS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Bristor 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.