Citation Nr: 20044530 Decision Date: 07/02/20 Archive Date: 07/02/20 DOCKET NO. 12-19 126 DATE: July 2, 2020 ORDER Entitlement to service connection for endometriosis and sterility is denied. Entitlement to service connection for bilateral carpal tunnel syndrome is denied. FINDINGS OF FACT 1. The Veteran’s endometriosis and sterility did not manifest during service and are not otherwise etiologically related to her military service. 2. The Veteran’s bilateral carpal tunnel syndrome did not manifest during service and is not otherwise etiologically related to her military service. CONCLUSIONS OF LAW 1. Endometriosis and sterility were not incurred in active service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.102, 3.303. 2. Bilateral carpal tunnel syndrome was not incurred in active service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1992 to July 1995. She also had a period of active duty for training from May 1991 to November 1991, as well as additional service in the United States Army Reserve and the Georgia Army National Guard. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2010 rating decision. In August 2017, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the record. The Board remanded the case for further development in January 2019. That development was completed, and the case has since been returned to the Board for appellate review. Law and Analysis Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. 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). The disorders at issue in this case are not considered chronic diseases as enumerated for VA compensation purposes. As such, the provisions for continuity of symptomatology after discharge are not for application in this case. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the weight of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Endometriosis and Sterility In considering the evidence of record under the laws and regulations as set forth above, the Board concludes the Veteran is not entitled to service connection for endometriosis and sterility. The Veteran’s available service treatment records are negative for any complaints, treatment, or diagnosis of endometriosis. In fact, she was not diagnosed with the endometriosis until 2000. The only documented gynecological complaint noted in her service treatment records related to treatment for vaginitis in August 1991 after she presented with vaginal itching and discharge. The Board does acknowledge the Veteran’s contention that she had symptomatology in service that was an early manifestation of endometriosis or that her endometriosis was misdiagnosed during service. In this regard, during the August 2017 hearing, the Veteran testified that she was treated for various gynecological complaints while she was stationed at Fort Campbell. She indicated that she was diagnosed with severe menstrual cramps. The Veteran stated that she subsequently developed abdominal pain during a period of active duty for training (ACDUTRA) in 2000 and was diagnosed with endometriosis. However, the Veteran does not have a verified period of ACDUTRA for that time period. The evidence does show that the Veteran was first diagnosed with endometriosis in September 2000. Private treatment records document that a pelvic ultrasound showed a large abdominal mass in August 2000. The findings were inconclusive due to the size of the mass. The Veteran was referred to a private hospital for further evaluation. The Veteran subsequently underwent a left ovectomy, myomectomy, and appendectomy in September 2000. In a September 2000 discharge summary, it was noted that the Veteran had been complained of lower abdominal fullness and increased dysmenorrhea over the last several months. VA treatment records showed that the Veteran underwent a total hysterectomy in June 2010. The Veteran was serving in the Georgia Army National Guard in 2000; however, there are no service department records showing that she was serving on active duty, active duty for training, or inactive duty for training when she developed endometriosis. See Cahall v. Brown, 7 Vet. App. 232, 237 (1994). For these reasons, the Board finds that endometriosis did not manifest in service. In addition to the lack of evidence showing that endometriosis manifested during active service, the weight of the probative evidence of record does not relate the current disorder to the Veteran’s military service. A March 2020 VA examiner opined that it is not at least as likely as not that the Veteran’s endometriosis and sterility were causally or etiologically related to her military service. The examiner explained that there is no known cause of endometriosis; however, hormonal variations, early age at menarche, and short menstrual cycle are believed to be risk factors. The examiner noted that the Veteran subjectively reported an onset of endometriosis symptoms during active service, but the objective evidence contradicts her statements. The examiner specifically noted that the Veteran was treated during service in August 1991 for vaginitis and that the Veteran was referred to a private hospital in August 2000 secondary to a pelvic mass noted on an examination and pelvic ultrasound. She related that the Veteran’s only treatment during service was for vaginitis with symptoms of vaginal itching, irritation, and rash. The examiner reported that symptoms of endometriosis include intermenstrual bleeding, painful periods (dysmenorrhea), painful intercourse (dyspareunia), painful defecation (dyschezia), pelvic pain, and painful urination (dysuria), as discussed in medical literature. She noted that vaginal itching and irritation are not symptoms of endometriosis. The examiner further reported that a September 2000 private discharge summary indicated that the Veteran only had abdominal fullness and other symptoms associated with endometriosis for months prior to her admission, which indicated that the onset was closer to the 2000 date of her hospital admission. The examiner also noted that the Veteran reported that her 2010 hysterectomy surgery was a progression of symptoms from service. The examiner related that there is no evidence to support this contention. The Board acknowledges the Veteran’s assertions that she had symptoms of endometriosis that were misdiagnosed in service. However, such statements appear to be based on conjecture. Indeed, the diagnosis and etiology of endometriosis deals with an internal medical process, which extends beyond an immediately observable cause-and-effect relationship that is of the type that the courts have found to be beyond the competence of lay witnesses. Although lay persons are competent to provide opinions on some medical issues, Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issues in this case, the diagnosis and etiology of endometriosis and sterility, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). Moreover, even assuming that the Veteran is competent to opine on this medical matter, the Board finds that the specific, reasoned opinion of the March 2020 VA examiner is of greater probative weight than the Veteran’s more general lay assertions. The Board finds that the VA examiner provided the most probative medical opinion. The examiner reviewed and considered the evidence of record, including the Veteran’s statements; relied on her medical training, knowledge, and expertise; referenced medical literature; and provided thorough rationale for the conclusion reached. There is no medical opinion otherwise relating the Veteran’s endometriosis and sterility to her military service. For these reasons, the Board finds that the preponderance of the evidence is against a finding that endometriosis and sterility were incurred in service. As such, the benefit of the doubt rule does not apply, and the Veteran’s claim for service connection for endometriosis and sterility is denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Carpal Tunnel Syndrome In considering the evidence of record, the Board finds the Veteran is not entitled to service connection for bilateral carpal tunnel syndrome. The Veteran’s available service treatment records do not document any complaints, treatment, or diagnosis of carpal tunnel syndrome. Moreover, the evidence shows that the Veteran was not diagnosed with carpal tunnel syndrome for many years after her military service. In fact, the evidence of record indicates that the Veteran was not diagnosed with carpal tunnel syndrome until September 2005. See September 2005 private electromyographic report. The Board does acknowledge that the Veteran has reported that she was first diagnosed with carpal tunnel syndrome during her terminal leave from service in 1995. She related that she was a welder, which caused her carpal tunnel syndrome during service. During the August 2017 hearing, the Veteran indicated that she was seeking employment as a welder following service and that the company’s nurse referred her to a neurologist after she failed the medical screening portion due to carpal tunnel syndrome. The Veteran also testified that she was reactivated from the Individual Ready Reserves (IRR) in 2004, but she was medically released due to carpal tunnel syndrome. However, the Veteran submitted a VA wrist conditions Disability Benefits Questionnaire (DBQ) dated in October 2017 in support of her claim. In the DBQ, the examiner also indicated that the Veteran was diagnosed with bilateral carpal tunnel syndrome in June 2015. During the examination, the Veteran reported pain and tingling in both hands for only one year. For these reasons, the Board finds that bilateral carpal tunnel syndrome did not manifest in service. In addition to the lack of evidence showing that carpal tunnel syndrome manifested during active service, the weight of the probative evidence of record does not relate the current disorder to the Veteran’s military service. A March 2020 VA examiner opined that the Veteran’s current carpal tunnel syndrome was less likely than not incurred in or caused by her military service. The examiner noted the Veteran’s contentions that she was diagnosed with carpal tunnel syndrome in 1995 and that she was medically released due to carpal tunnel syndrome after being reactivated in 2004. The examiner noted that these subjective contentions are not supported by the objective findings of record. Specifically, the examiner reported that a September 2005 EMG showed mild bilateral carpal tunnel syndrome. The examiner indicated that the Veteran’s service treatment records were silent for complaints of wrist pain or carpal tunnel syndrome symptoms. The examiner also noted that the Veteran was a welder during service, and she related that repeated use of hands to type, write, or jobs that involved repeated wrist motion can cause carpal tunnel syndrome; however, there were no complaints or treatment for symptoms during service. The Board acknowledges the Veteran’s assertions that she first began experiencing symptoms of carpal tunnel syndrome in service and that her current disorder is related to service. However, such statements contradict her report in an October 2017 DBQ that she had had pain and tingling in both hands for only one year. In addition, the diagnosis and etiology of carpal tunnel syndrome deals with an internal medical process that requires objective testing, which extends beyond an immediately observable cause-and-effect relationship that is of the type that the courts have found to be beyond the competence of lay witnesses. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Moreover, even assuming that the Veteran is competent to opine on this matter, the Board finds that the specific, reasoned opinion of the March 2020 VA examiner has greater probative weight than the Veteran’s more general lay assertions. The examiner reviewed and considered the evidence of record, including the Veteran’s statements; relied on his own medical training, knowledge, and expertise; and provided a thorough rationale for the conclusion reached. There is no medical opinion otherwise relating the Veteran’s current bilateral carpal tunnel syndrome to her military service. For these reasons, the Board finds that the preponderance of the evidence is against finding that bilateral carpal tunnel syndrome was incurred in service. As such, the benefit of the doubt rule does not apply, and the Veteran’s claim for service connection for bilateral carpal tunnel syndrome is denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Osegueda, 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.