Citation Nr: 21002862 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 14-39 815 DATE: January 19, 2021 ORDER Entitlement to service connection for endometriosis is denied. FINDING OF FACT A diagnosis of endometriosis has not been shown at any time during the appeal period. CONCLUSION OF LAW The criteria for service connection for endometriosis are not met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served active duty in the United States Air Force from February 2000 to June 2001. This matter originally came before the Board of Veterans’ Appeals (Board) on appeal from a March 2012 decision from the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. In October 2018, the Veteran testified before the undersigned Veterans Law Judge (VLJ) via live videoconference. A transcript of the proceeding has been associated with the record. In May 2019, the Board remanded the matter for additional development. The Board finds that there has been substantial compliance with its remand directives and the matter is properly before the Board. Stegall v. West, 11 Vet. App. 268 (1998) (a remand confers upon the claimant, as a matter of law, the right to compliance with the remand directives). Duty to Notify and Assist The appellant has not raised any issues with the duty to notify or duty to assist. Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings liberally does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Service Connection Service connection requires evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus, or link, between the current disability and the in-service disease or injury. 38 C.F.R. § 3.303(a); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). In each case where a veteran is seeking service connection for a disability, due consideration shall be given to the places, types, and circumstances of the veteran’s service as shown by the veteran’s service record, the official history of each organization in which the veteran served, the veteran’s treatment records, and all pertinent medical and lay evidence. See 38 U.S.C. § 1154(a). Additionally, service connection may be granted on a secondary basis. Secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. To prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). In making all determinations, the Board must consider fully the lay assertions of record. A layperson is competent to report on the onset and recurrent symptoms. 38 C.F.R. § 3.159. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence also can be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011). The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence, which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the appellant. Equal weight is not necessarily accorded to each piece of evidence contained in the record; not every item of evidence necessarily has the same probative value. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Entitlement to service connection for endometriosis The Veteran contends that entitlement to service connection for endometriosis is warranted because the condition was caused as a result of active duty service. A review of the record shows that the Veteran is currently service connected for vaginitis (claimed as vaginosis), pelvic inflammatory disease (PID), and residuals of ectopic pregnancy with removal of left fallopian tube and fetus, including residual painful left lower quadrant surgical scarring associated with the aforementioned condition. During the October 2018 hearing before the undersigned VLJ, the Veteran and her representative reported symptoms of several overlapping conditions similar to vaginosis and PID, that did not have a clear diagnosis and agreed that a VA examination was needed to clarify diagnosis, including endometriosis. See October 2018 hearing transcript. The Veteran was afforded a VA examination in November 2019. The Veteran reported that she had a diagnosis of endometriosis since 2002-2003. The VA examiner reviewed the evidence of record and noted that the Veteran does not have a current diagnosis for endometriosis, although extensive treatment and diagnosis for bacterial vaginosis was noted. A diagnosis of dysfunctional uterine bleeding and uterine fibroids was also noted. A review of the Veteran’s service, private and VA treatment records do not show a diagnosis of endometriosis. Based on the foregoing, the examiner opined that the Veteran’s claimed condition was less likely than not (less than 50 percent probability) incurred in, or caused by the claimed in-service injury, event, or illness. An October 2020 VA examination for acquired absence of uterus and cervix post-hysterectomy, status post uterine fibroids, a previous July 2013 VA gynecological examination and a December 2011 VA gynecological examination also did not note a diagnosis of endometriosis. In the absence of proof of a current disability, there can be no valid claim for service connection. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Giplin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (indicating service connection presupposes a current diagnosis of the condition claimed). Service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or disease incurred in service. Watson v. Brown, 4 Vet. App. 309, 314 (1993); see also Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). In this case, the evidence does not indicate a diagnosis of endometriosis. Accordingly, service connection is not warranted for endometriosis as there is no current diagnosis. Brammer, 3 Vet. App. at 225. The Board has considered lay statements from the Veteran and her representative, including the October 2018 hearing testimony. However, a diagnosis of endometriosis requires specialized testing and medical analysis that is beyond the capacity of a lay person. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The record does not show that the Veteran or her representative possess the requisite medical knowledge to make such a determination whether the gynecological symptoms reported by the Veteran were caused due to endometriosis. Based on a review of the foregoing evidence and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran's claims for entitlement to service connection for endometriosis. In reaching the foregoing conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C.§ 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Khan, 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.