Citation Nr: 21003289 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 15-12 536 DATE: January 21, 2021 ORDER The claim for a rating higher than 10 percent for a left wrist strain with loss of motion is denied. The claim for an initial rating of 20 percent, but not higher, for left wrist scars is granted. The claim for a rating higher than 10 percent for a left knee strain with instability is denied. The claim for a separate rating of 10 percent for painful motion of the left knee is granted. The claim for a rating higher than 10 percent for vaginitis is denied. The claim for a compensable rating for acne is denied. The claim for service connection for a gynecological disability, claimed as pelvic inflammatory disease (PID) and a laparoscopic hysterectomy, to include as secondary to service-connected disability, is denied. FINDINGS OF FACT 1. The Veteran’s left wrist strain manifests pain and limited motion without ankylosis. 2. The Veteran has four left wrist scars that are tender and painful; the scars are not unstable, due to a burn, do not involve the head, face, or neck, and do not result in any functional impairment. 3. The Veteran’s left knee strain manifests instability that is no more than slight. 4. The Veteran’s left knee strain manifests painful range of motion with flexion limited at most to 110 degrees with full extension; there is no ankylosis, impairment of the tibia or fibula, or frequent episodes of locking, dislocation, and joint pain. 5. The Veteran’s vaginitis manifests recurrent yeast infections that are controlled with over-the-counter and prescribed antifungal medications. 6. The Veteran’s acne manifests a superficial acneiform rash and pustules on the chin, cheeks, and forehead regions and occasionally the chest. 7. The Veteran does not have PID; her laparoscopic hysterectomy in October 2011 was not etiologically related to a disease or injury in service, and was not caused or aggravated by a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for a rating higher than 10 percent for a left wrist strain with loss of motion are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.14, 4.71a, Diagnostic Codes 5214, 5215. 2. The criteria for an initial rating of 20 percent, but not higher, for left wrist scars are met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.118, Diagnostic Code 7800-7805. 3. The criteria for a rating higher than 10 percent for a left knee strain with instability are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.71a, Diagnostic Code 5257. 4. The criteria for a separate rating of 10 percent, but not higher, for a left knee strain with painful limited motion throughout the claims period are met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5256, 5258-5263. 5. The criteria for a rating higher than 10 percent for vaginitis are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.116, Diagnostic Code 7611. 6. The criteria for a compensable rating for acne are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.118, Diagnostic Code 7828. 7. PID and a laparoscopic hysterectomy were not incurred or aggravated during active duty service, and were not caused or aggravated by a service-connected disability. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1989 to March 1993. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a videoconference hearing in February 2018. A transcript of the hearing is of record. This case was previously before the Board in June 2018 when it was remanded for additional development. It has now returned to the Board for further appellate action. When the case was previously before the Board, the issues on appeal included entitlement to service connection for posttraumatic stress disorder (PTSD) and allergic rhinitis. Service connection for these disabilities was granted by the agency of original jurisdiction (AOJ) in a June 2020 rating decision. The award of service connection represents a full grant of the benefits sought on appeal, and the claims for service connection for PTSD and allergic rhinitis are no longer before the Board. Increased Rating Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. Where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibits symptoms that would warrant different evaluations at any point during the appeal, the assignment of staged ratings is appropriate. See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). For disabilities evaluated based on limitation of motion, VA is required to apply the provisions of 38 C.F.R. §§ 4.40, 4.45, pertaining to functional impairment. See also DeLuca v. Brown, 8 Vet. App. 202 (1995); Johnston v. Brown, 10 Vet. App. 80, 84-5 (1997); 38 C.F.R. § 4.59. 1. Entitlement to a rating higher than 10 percent for left wrist strain with loss of motion. Service connection for residuals of a left wrist injury was granted in a June 1995 rating decision with an initial 10 percent evaluation assigned effective March 13, 1995. The December 2010 rating decision on appeal recharacterized the disability as a left wrist strain with loss of range of motion and continued the current 10 percent evaluation. The Veteran contends that a higher rating is warranted for her left wrist disability due to loss of motion and impairment to lifting and gripping. The Board finds that a rating higher than 10 percent is not warranted for the service-connected left wrist condition. The current rating is assigned under Diagnostic Code 5215 for limitation of motion of the wrist. The lay and medical evidence establishes that the Veteran experiences pain and accompanying loss of motion of the left wrist. However, she is in receipt of a 10 percent rating for painful and limited motion throughout the claims period and this is the maximum evaluation possible under Diagnostic Code 5215 for limitation of motion of the wrist. See 38 C.F.R. § 4.71a, Diagnostic Code 5215. A higher rating is possible under Diagnostic Code 5214 for ankylosis of the wrist, but the record shows that the Veteran’s left wrist is not ankylosed. VA and private examiners who physically examined the Veteran’s wrist in March 2009, January 2010, and January 2020 found that the Veteran maintained some useful motion of the wrist and it was not ankylosed. The Veteran clearly experiences reduced motion of the left wrist, but none of the lay or medical evidence establishes that the disability manifests ankylosis. Furthermore, as the Veteran is already in receipt of the highest available rating based on restriction of motion, the provisions regarding pain in 38 C.F.R. §§ 4.40 and 4.45 do not apply. Johnson v. Brown, 9 Vet. App. 7, 11 (1996). Therefore, the assignment of a rating higher than 10 percent for the service-connected left wrist disability based on ankylosis under Diagnostic Code 5214 is not appropriate. In sum, the Veteran’s left wrist strain warrants a 10 percent rating, but not higher, throughout the claims period. The Board has considered the doctrine of reasonable doubt but has determined that it is not applicable because the preponderance of the evidence is against a higher schedular rating. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.7, 4.21. 2. Entitlement to an initial rating higher than 10 percent for left wrist scars. Service connection for residual scars of a left wrist injury was granted in the December 2010 rating decision on appeal. An initial 10 percent evaluation was assigned effective September 29, 2009. The Veteran contends that a higher initial evaluation is warranted as she has four left wrist scars that are painful and tender, especially when her left wrist swells, or she wear long-sleeved shirts that brush against the scars. During the pendency of this appeal, the rating criteria for the skin were amended effective August 13, 2018. 83 Fed. Reg. 32592 (July 13, 2018). The change affected Diagnostic Codes 7801, 7802, 7805, and 7806, but did not alter Diagnostic Code 7804, which is the code used to rate the Veteran’s scars. As an initial matter, the Board notes that there is some disagreement in the record as to the total number of scars present on the Veteran’s left wrist. A September 2010 VA examiner observed the presence of three total scars, but the most recent VA examination in January 2020 indicated the presence of four scars. The Veteran testified in February 2018 that she had four scars on her left wrist related to in-service wrist fusion surgery, and she is certainly competent to report the number of scars. The Board therefore finds that the Veteran manifests four total scars on her left wrist. The Board finds that an initial rating of 20 percent, but not higher, for the Veteran’s left wrist scars is warranted throughout the claims period. The current 10 percent evaluation is assigned under Diagnostic Code 7804 which provides for a 10 percent rating for one or two scars that are unstable or painful. 38 C.F.R. § 4.118. Although a September 2010 VA examination noted the presence of three total left wrist scars, the current 10 percent evaluation was assigned as the VA examiner found that only two of the two scars were painful on examination. The Board finds that a higher 20 percent initial rating is appropriate as the competent lay evidence establishes that all the Veteran’s left wrist scars are tender and painful, particularly when her left wrist is swollen, or she wears long-sleeves that rub against the scars. Diagnostic Code 7804 provides for a 20 percent evaluation for three or four scars that are unstable or painful. 38 C.F.R. § 4.118, Diagnostic Code 7804. The Veteran testified in February 2018 that her scars were painful, and the September 2010 VA examiner also recorded the Veteran’s statements that her scars were aggravated by wearing long-sleeves or when the wrist joint was swollen. Although the medical evidence (including the findings of the September 2010 and January 2020 VA examiners) does not establish the presence of more than two painful scars, the Veteran is competent to report that her left wrist scars are painful and the Board finds that her statements are credible. Thus, an initial 20 percent rating is warranted for the Veteran’s left wrist scars under Diagnostic Code 7804. The Board has considered whether there is any other schedular basis for granting a higher rating, but has found none. There is no lay or medical evidence that any of the four wrist scars are unstable with frequent loss of covering of the skin over the scar. The service-connected scars are also not due to a burn, are not located on the head, face, or neck, and have not resulted in any disabling effects not considered by Diagnostic Code 7804, such as limitation of motion or other impairment. The other diagnostic codes for rating scars are therefore not for application in this case. The Board has also considered the doctrine of reasonable doubt but has determined that it is not applicable in this case because the preponderance of the evidence is against the assignment of a higher rating. 3. Entitlement to a rating higher than 10 percent for a left knee strain. Service connection for residuals of a left knee injury was granted in a June 1995 rating decision with an initial 10 percent evaluation assigned effective March 13, 1995. The December 2010 rating decision on appeal recharacterized the disability as a left knee strain and continued the current 10 percent evaluation. The Veteran contends that a higher rating is warranted as her left knee is productive of painful motion, instability that requires bracing, and limits her to low impact activities. The Board finds that an increased rating is not warranted under the criteria for evaluating the Veteran’s left knee instability, but does find that a separate 10 percent evaluation is warranted for painful motion of the right knee in accordance with 38 C.F.R. § 4.59. The Veteran’s left knee strain is currently rated as 10 percent disabling under Diagnostic Code 5257-5260 (indicating impairment of the left knee with instability and limitation of motion). Under Diagnostic Code 5257, recurrent subluxation or lateral instability warrants a 10 percent evaluation if it is slight, a 20 percent evaluation if it is moderate, or a 30 percent evaluation if it is severe. 38 C.F.R. § 4.71a, Diagnostic Code 5257. Thus, the Veteran’s current 10 percent rating is associated with instability that is no more than mild. The Board finds that a rating higher than 10 percent is not warranted under Diagnostic Code 5257 for knee instability. The only objective finding of instability dates from a November 2009 evaluation at the VA Medical Center (VAMC) when the Veteran’s knee was mildly painful during varus testing. The left knee was stable during testing at September 2010 and January 2020 VA examinations. The Veteran testified in February 2018 that she has worn a knee brace with stabilizers for almost a decade due to left knee instability and experienced her left knee “giving out” when she worked on her feet all day. The Veteran is competent to report instability of the left knee, but the Board finds that the medical evidence of record (based on objective testing) is more probative regarding the severity of the left knee instability. As there is only one documented instance of instability during objective testing and stable findings on various VA examinations, the Board cannot conclude that the Veteran’s knee instability most nearly approximates moderate in severity. Accordingly, the current 10 percent rating for slight instability is the appropriate evaluation for the Veteran’s left knee disability under Diagnostic Code 5257. Although a higher rating is not warranted for the left knee instability, the Board finds that a separate rating of 10 percent is appropriate based on painful left knee motion under 38 C.F.R. § 4.59. In 38 C.F.R. § 4.59, VA recognized that the intent of the rating schedule to recognize painful motion of a joint as productive of disability. Therefore, actually painful healed injuries are “entitled to at least the minimum compensable rating for the joint.” Id. The Veteran was initially service connected for residuals of a left knee injury and experiences painful limited motion of the left knee that is not compensable under the criteria pertaining to limitation of flexion and extension of the left knee. A separate 10 percent rating is therefore appropriate under 38 C.F.R. § 4.59 for painful limited motion; a manifestation of the left knee disability that is separate and distinct from the instability rated under Diagnostic Code 5257. The Board has considered whether higher ratings are possible under the criteria specifically pertaining to limitation of motion of the knee. For rating purposes, normal range of motion in a knee joint is from 0 to 140 degrees. 38 C.F.R. § 4.71, Plate II. Limitation of flexion of a leg warrants a 10 percent evaluation if flexion is limited to 45 degrees and a 20 percent evaluation is assigned if flexion is limited to 30 degrees. Flexion that is limited to 15 degrees is evaluated as 30 percent disabling. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Limitation of extension of a leg warrants a 10 percent evaluation when it is limited to 10 degrees and a 20 percent evaluation when it is limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261. Throughout the claims period, the Veteran has manifested noncompensable limitation of motion of the left knee that most nearly approximates full extension (0 degrees) and flexion to 110 degrees or better. Upon VA examination in January 2020, the Veteran’s left knee manifested flexion limited to 110 degrees with full extension to 0 degrees. This represents the most restricted motion of the left knee during the claims period. This amount of knee motion is noncompensable under Diagnostic Codes 5260 and 5261 and is contemplated by the current 10 percent evaluation under 38 C.F.R. § 4.59. The Board has also considered whether a higher rating is warranted with consideration of functional factors. The Veteran did not manifest any pain during range of motion testing at the September 2010 and January 2020 VA examinations and both examiners found that there was no additional loss of motion following repetitive testing. The January 2020 examiner noted that the Veteran would experience limited functional ability over time or during flare-ups, but also opined that no further loss of motion was anticipated with repeated use over time or with flares. The impact of the left knee disability was described as limiting prolonged walking, running, climbing stairs, climbing up and down hills, and getting in and out of high vehicles, but the Board finds that this type of impairment is contemplated by the Veteran’s two compensable ratings for left knee instability and painful motion. Similarly, the Veteran’s testimony describing her functional limitations due to her left knee condition (impairing her ability to stand or walk for prolonged periods of perform other high-impact exercises) are considered by the assignment of two 10 percent evaluations. The left knee strain has clearly resulted in functional impairment, but the objective medical evidence establishes that this impairment has not resulted in limitation of motion greater than 110 degrees of flexion or less than full extension. The Board therefore finds that the Veteran’s left knee manifests noncompensable limitation of motion even with consideration of all relevant factors. A 10 percent rating based on painful limited motion is therefore appropriate throughout the claims period under 38 C.F.R. § 4.59. The Board has considered whether there is any other schedular basis for granting a higher rating, but has found none. The Veteran’s treating and examining providers have observed some instances of small effusions in the left knee joint during the claims period, but there is no evidence of dislocated semilunar cartilage or findings of a meniscal condition to allow for a 20 percent rating under 38 C.F.R. § 4.71a, Diagnostic Code 5258. The Veteran has also not demonstrated knee ankylosis or impairment of the tibia and fibula and Diagnostic Codes 5256 and 5262 are not for application. Therefore, the Veteran’s left knee is properly rated as 10 percent disabling based on instability under Diagnostic Code 5257 and 10 percent disabling for painful noncompensable limitation of motion under 38 C.F.R. § 4.59. 4. Entitlement to a rating higher than 10 percent for vaginitis. Service connection for vaginitis was granted in an October 1995 rating decision with an initial 10 percent evaluation assigned effective March 13, 1995. The December 2010 rating decision on appeal continued the current 10 percent evaluation. The Veteran contends that a higher rating is warranted as she experiences yeast infections approximately once a month requiring treatment with antifungal medication that affects her sexual relationship with her spouse. The service-connected vaginitis is currently rated as 10 percent disabling under Diagnostic Code 7611 pertaining to disease or injury of the vagina. This diagnostic code is rated under the General Rating Formula for Disease, Injury, or Adhesions of Female Reproductive Organs (Diagnostic Codes 7610 through 7615) which provides for a 10 percent disability rating for symptoms that require continuous treatment and a maximum 30 percent rating for symptoms not controlled by continuous treatment. 38 C.F.R. § 4.116. After review of the evidence, the Board finds that a rating higher than 10 percent for vaginitis is not warranted as the Veteran’s disability is controlled with treatment. VA treatment records show that the Veteran reported experiencing recurrent yeast infections in September 2009 and August 2014 treated with over-the-counter antifungals and a prescribed antifungal, Difulcan. The Veteran’s testimony and statements to VA examiners establish that she experiences a yeast infection approximately once a month which is treated with antifungals for several days. The January 2010 VA examiner found that Difulcan was an “effective” treatment for the Veteran’s vaginitis, while the January 2020 VA examiner noted that the treatment was intermittent and not continuous for the Veteran’s yeast infections. There is no lay or medical evidence that the Veteran’s vaginitis is not controlled by antifungal medication and there is no evidence of other treatment for the condition during the claims period. The Board has considered the Veteran’s testimony and statements regarding her vaginitis, but finds that her recurrent yeast infections and accompanying symptoms of itching and discharge are contemplated by the current 10 percent evaluation which provides for a disability requiring continuous medication. In addition, there is no lay or medical evidence of functional impairment associated with the service-connected disability. The Board therefore finds that an evaluation higher than 10 percent is not warranted for vaginitis and the claim for an increased rating is denied. 5. Entitlement to a compensable rating for acne. Service connection for acne was granted in a June 1995 rating decision with an initial noncompensable (0 percent) evaluation assigned effective March 13, 1995. The December 2010 rating decision on appeal continued the noncompensable evaluation. The Veteran contends that a compensable rating is warranted as her acne requires multiple treatments, is painful to the touch, and affects most of her face. The Veteran’s acne is rated as noncompensably disabling under Diagnostic Code 7828 pertaining to acne. This diagnostic code allows for rating acne under the specific criteria listed or by analogy to disfigurement of the head, face, or neck (Diagnostic Code 8100) or scars (Diagnostic Codes 7801-7805), depending on the predominant disability. In this case, the Veteran’s disability is more appropriately rated as acne and the criteria contained in Diagnostic Code 7828. Although the condition primarily affects the Veteran’s face, there is no lay or medical evidence that it is considered disfiguring or manifests any of the characteristics of disfigurement specified by Diagnostic Code 7800. The January 2020 VA examiner also specifically found that the Veteran’s condition had no associated disfigurement. With regard to scarring, the January 2010 VA examiner found that the Veteran had some hyperpigmentation scarring of the face associated with acne, but Diagnostic Code 7828 provides for rating a skin condition based on the predominant disability. The evidence establishes that the Veteran’s acne predominantly manifests recurrent acne lesions, rash, and pustules rather than scarring. Thus, rating the disability under the specific criteria contained in Diagnostic Code 7828 is appropriate. VA amended the criteria for rating skin disabilities several times since service connection for acne was established in 1995 and specifically during the pendency of this claim effective in August 13, 2018. Diagnostic Code 7828 was not altered with the August 2018 change in criteria. The rating criteria pertaining to disfigurement and scars were affected by the regulatory change, but as the Board has determined that the Veteran’s disability is more appropriately evaluated under the criteria specified in Diagnostic Code 7828, consideration of the previous criteria is not necessary. Under Diagnostic Code 7828, a 30 percent evaluation is assigned for deep acne (deep inflamed nodules and pus-filled cysts) affecting 40 percent or more of the face and neck. A 10 percent evaluation is assigned for deep acne (deep inflamed nodules and pus-filled cysts) affecting less than 40 percent of the face and neck, or; deep acne other than on the face and neck. A noncompensable evaluation is assigned for superficial acne (comedones, papules, pustules, superficial cysts) of any extent. 38 C.F.R. § 4.118, Diagnostic Code 7828. The Board finds that a compensable rating is not warranted for the Veteran’s acne as the condition most nearly approximates superficial acne. VA treatment records dated throughout the claims period establish the presence of recurrent acne lesions on the chin, cheeks, forehead, and occasionally the chest. A February 2010 dermatology evaluation at the VAMC described the lesions as “hyperpigmented macules and healing pustules,” as well as “hyperpigmented lesions.” The Veteran’s acne was characterized by her treating dermatologists as cystic acne, but there is no evidence of deep acne, defined by Diagnostic Code 7828 as deep inflamed nodules and pus-filled cysts. VA examiners in January 2010 and January 2020 specifically characterized the Veteran’s acne condition as superficial and noted the presence of superficial comedones on the face, as well as “scattered comedones and papules with some areas of post-inflammatory hyperpigmentation.” Superficial acne characterized by comedones, papules, pustules, and superficial cysts is contemplated by the current noncompensable evaluation under Diagnostic Code 7828. The Board has considered the Veteran’s testimony and statements regarding her acne condition, but the weight of the competent evidence clearly establishes that the acne is superficial in nature and a compensable rating is not warranted under the relevant rating criteria. The Board therefore finds that the evidence is against the Veteran’s claim for a compensable rating for acne. Service Connection 6. Entitlement to service connection for PID, to include as secondary to service-connected disability. The Veteran contends that service connection is warranted for a gynecological disability claimed as PID. The question for the Board is whether the Veteran has a current gynecological 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 the Veteran does not have PID, and has not had the condition at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). To the extent the Veteran also claims that service connection is warranted for her laparoscopic hysterectomy, there is no link between this condition and active service or a service-connected disability. Service treatment records show that the Veteran was treated for several gynecological complaints during active duty. She is currently service connected for vaginitis and was treated on multiple occasions for yeast infections. Additionally, she complained of lower abdominal and pelvic pain in March and April 1990, and in November 1989 was diagnosed with possible PID. However, the Veteran’s pelvic examination was normal at the December 1992 examination for separation and there are no definitive findings of PID during active duty. Additionally, the Board observes that injuries and conditions documented during active service are not sufficient to establish the presence of a current disability. The requirement of a current disability is met by evidence of symptomatology at the time of filing or at any point during the pendency of the claim. McClain v. Nicholson, 21 Vet. App. 319, 323 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013) (finding that the Board must address pre-claim evidence in assessing whether a current disability existed, for purposes of service connection, at the time the claim was filed or during its pendency). In this case, service records only document a finding of possible PID, and this evidence cannot serve to establish the presence of a current disability during the applicable claims period. The post-service evidence also does not establish the presence of PID. Post-service medical records document ongoing treatment for the Veteran’s service-connected vaginitis, as well as uterine fibroids and associated menometrorrhagia (abnormally heavy and prolonged period bleeding) and dysmenorrhea (menstrual cramps). In May 2004, the Veteran reported that she believed she was diagnosed with PID at the age of 18 or 19, but there is no competent evidence of PID in the post-service medical records. A VA examiner in January 2020 found that there was no evidence of a prior evaluation or treatment for PID with no pelvic pain or symptoms to produce impairment. Additionally, as the Veteran underwent a hysterectomy in October 2011 and PID is a condition involving the uterus, the VA examiner noted that it was not possible for PID to exist after the laparoscopic removal of the Veteran’s uterus. Based on the contents of the post-service treatment records and the January 2020 VA examination, the Board finds that PID is not demonstrated by the competent post-service medical evidence. The Board further observes that there is no lay or medical evidence of actual functional impairment related to the Veteran’s claimed PID. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir., 2018) (holding that the term “disability” as used in 38 U.S.C. § 1110 “refers to the functional impairment of earning capacity, not the underlying cause of said disability,” and that “pain alone can serve as a functional impairment and therefore qualify as a disability.”). In this case, the Veteran contends that she was diagnosed with PID during active service, but has not described any impairment related to that finding during the applicable claims period. Thus, the record does not establish any actual impairment associated with the claimed PID. The Board has also considered the Veteran’s statements that she manifests PID, but finds that the Veteran lacks the expertise to specifically diagnose herself with this chronic disability. See Charles v. Principi, 16 Vet. App. 370, 374 (2002) (finding veteran competent to testify as to ringing in the ears (tinnitus); Jandreau v. Nicholson, 492 F.3d 1372, 1377, Note 4 (Fed. Cir. 2007). The Veteran is competent to describe the symptoms manifested by the claimed disability, but considering the her other diagnosed gynecological conditions, including service-connected vaginitis, the Board finds that the Veteran is not competent to determine that she manifests PID, especially after 2011 and the removal of her uterus. Therefore, the record establishes that the Veteran does not have a chronic gynecological disability diagnosed as PID. Absent proof of the existence of the disability being claimed, there can be no valid claim. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Degmitech v. Brown, 104 F.3d 1328 (Fed. Cir. 1997); Brammer v. Derwinski, 3 Vet. App. 223 (1992); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). Accordingly, the preponderance of the evidence is against the claim and it is denied. As a final matter, to the extent the Veteran may claim that service connection is warranted for the cause of her laparoscopic hysterectomy, the Board finds that there is no competent evidence of a link between the removal of the Veteran’s uterus and active service or a service-connected disability. In January 2011, more than 10 years after separation from service, the Veteran reported that she was experiencing heavy and painful periods. A May 2011 pelvic ultrasound demonstrated the presence of uterine fibroids and in June 2011 she requested a hysterectomy to treat menometrorrhagia, dysmenorrhea, and leiomyoma of the uterus (fibroids). A robotic laparoscopic supracervical hysterectomy was performed on October 28, 2011. None of the Veteran’s treating physicians indicated that the Veteran’s hysterectomy was necessary due to any events of service, to include the Veteran’s diagnosis of genital warts during active duty, or was caused or aggravated by service-connected vaginitis. The January 2020 VA examiner also specifically found that the October 2011 hysterectomy was performed due to uterine fibroids and associated menometrorrhagia; the examiner also stated that genital warts and vaginitis were not risk factors for the Veteran’s condition. The Board therefore finds that the competent evidence of record establishes that the Veteran’s hysterectomy was not performed due to PID and is not etiologically   related to active service or a service-connected disability. The claim for service connection for a gynecological disability is therefore denied. M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Riley, 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.