Citation Nr: 20042327 Decision Date: 06/22/20 Archive Date: 06/22/20 DOCKET NO. 11-11 871A DATE: June 22, 2020 ORDER Entitlement to service connection for a vaginal cyst is denied. Entitlement to service connection for a breast cyst is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that a vaginal cyst began during active service, or is otherwise related to an in-service injury or disease. 2. The preponderance of the evidence is against finding that a breast cyst began during active service, or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a vaginal cyst are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for a breast cyst are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty for training (ACDUTRA) from February 1981 to July 1981. The Board of Veterans’ Appeals (Board) most recently remanded the issues on appeal to the Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ) in January 2019. As the actions specified in the remand have been completed, the matter has been properly returned to the Board for appellate consideration. See Stegall v. West, 11 Vet. App. 268 (1998). In September 2019, the Veteran appointed the National Association of County Veterans Service Officers (as reflected in a VA Form 21-22, Appointment of Veterans Service Organization as Claimant’s Representative). The Board has recognized the change in representation. Service Connection Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if preexisting such service, was aggravated thereby. To establish a right to compensation for a present disability, a veteran must show (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, or nexus, 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). Reasonable doubt concerning any matter material to the determination is resolved in the Veteran’s favor. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. A “veteran” is “a person who served in the active military, naval, or air service, and who was discharged or released there from under conditions other than dishonorable.” 38 U.S.C. § 101 (2); 38 C.F.R. § 3.1 (d). Active duty for training (ACDUTRA) is, among other things, full-time duty in the Armed Forces performed by Reservists for training purposes or by members of the National Guard of any state. 38 U.S.C. § 101 (22); 38 C.F.R. § 3.6 (c)(1). ACDUTRA is not defined as “active” service unless the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty while performing ACDUTRA. 38 U.S.C. § 101 (24); 38 C.F.R. § 3.6 (a). A claimant whose claim is based on a period of ACDUTRA or inactive duty training (INACDUTRA) cannot be entitled to the presumption of service connection for enumerated diseases. Smith v. Shinseki, 24 Vet. App. 40, 47 (2010); see also 38 U.S.C. §§ 101 (24) (B), 1112, 1137; 38 C.F.R. §§ 3.6 (a), 3.307(a). Therefore, service connection may be granted for disability resulting from disease or injury incurred in, or aggravated, while performing ACDUTRA. 38 U.S.C. §§ 101 (24), 106, 1110, 1131. INACDUTRA is not defined as “active” service unless the individual concerned was disabled or died from an injury incurred or aggravated in line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident which occurred during such training. Id. In this case, the Veteran has established service connection for persistent depressive disorder/anxiety disorder, not otherwise specified/posttraumatic stress disorder (PTSD) based on her verified period of ACDUTRA. See October 2015 rating decision. Entitlement to service connection for a vaginal cyst and a breast cyst The Veteran asserts that her vaginal and breast cysts are a result of being sexually assaulted during her service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran reports vaginal cysts and breast cysts since active service, the preponderance of the evidence weighs against finding that her breast and vaginal conditions began during service or are otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Initially, the Board notes that the Veteran’s service treatment records (STRs) do not reflect any complaints, findings, treatment, or diagnosis of a vaginal cyst or breast cyst. Post-service, in May 2007, the Veteran underwent a mammogram with benign findings. In June 2015, the Veteran underwent another mammogram. Fatty and somewhat atrophic stromal tissue was noted, but was similar to prior studies. No suspicious new lesions were noted. In her October 2018 brief, the Veteran’s representative noted that the Veteran was repeatedly raped during her service and that her vaginal and breast cysts are related to her in-service trauma. In January 2020, the Veteran underwent a VA examination for breast conditions. The examiner reviewed the Veteran’s file. The Veteran was not diagnosed with a disorder of the breast. The Veteran reported cysts developing around her nipples with onset in 2000. She had the cysts removed as they would develop. She reported that her last cyst was removed in 2006. She did not have breast cysts at the time of the examination. Mammograms from June 2017 and November 2018 noted normal findings. The VA examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. She explained that the Veteran reported having a breast cyst by history; however, mammograms repeatedly found normal results. The examiner found that had the Veteran had a breast cyst, it was more likely than not related to general constitution and heritability, as well as environmental factors. The Veteran did not breastfeed any of her children and this increases the risk of irregular breast tissue. Also, the record noted that the Veteran contended repeated sexual assault during active service which may have caused a breast cyst; however, the Veteran made no reference to this during the examination. The objective examination was normal; therefore, no diagnosis was given. The examiner’s opinion is probative, because it is based on an accurate medical history, review of all relevant lay and medical evidence, and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board notes that there is no competent, credible, and probative opinion of record contrary to the VA examiner’s opinion including the Veteran’s lay statements. The Board finds that the VA medical opinion is the most probative evidence of record. In January 2020, the Veteran underwent a VA examination for gynecological conditions. The examiner reviewed the Veteran’s file. The Veteran was not diagnosed with a gynecological disorder. The Veteran reported that she had dilation and curettage prior to her pregnancy of her youngest child born in 1992. She reported bleeding in a brisk manner after her last delivery. She was diagnosed with anemia. She continued to have heavy bleeding as her menses were irregular and heavy. This continued until her hysterectomy in October 2007. She has not had bleeding since. Her symptoms included urinary incontinence, urinary tract infections (UTIs), soreness of the external labia majora, and occasional hot flashes. The examiner stated that there was no evidence to support a diagnosis of vaginal cysts. Urinary incontinence, intermittent vulvovaginitis, and recurrent UTIs are symptoms of larger problems, but none of these diagnoses are described by the Veteran or are in the records. At the time of the examination, the Veteran had no symptoms to evaluate. The Veteran demonstrated a lack of insight regarding the different parts and names of the female anatomy. No hysterectomy scar was found. It could have faded. The only finding available were statements by the Veteran. The VA examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. She explained that the Veteran reported having a vaginal cyst by history; however, no objective record or observation of a vaginal cyst could be located in the file. The only references to a vaginal cyst in the record were subjective statements made by the Veteran. Also, the record noted that the Veteran contended repeated sexual assault during active service which may have caused a vaginal cyst; however, the Veteran made no reference to this during the examination. The objective examination was normal; therefore, no diagnosis was given. The examiner’s opinion is probative, because it is based on an accurate medical history, review of all relevant lay and medical evidence, and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board notes that there is no competent, credible, and probative opinion of record contrary to the VA examiner’s opinion including the Veteran’s lay statements. The Board finds that the VA medical opinion is the most probative evidence of record. In reaching the conclusions above, the Board has considered the applicability of the benefit of the doubt doctrine, however, as the preponderance of the evidence is against the Veteran’s claims for service connection for a breast cyst and service connection for a vaginal cyst, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). Therefore, the Veteran’s claims for service connection for a breast cyst and service connection for a vaginal cyst are denied. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Costello, 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.