Citation Nr: 21003974 Decision Date: 01/25/21 Archive Date: 01/25/21 DOCKET NO. 14-28 889A DATE: January 25, 2021 ORDER Entitlement to service connection for a hysterectomy is denied. FINDING OF FACT The preponderance of the evidence is against a finding that the Veteran’s gynecological condition and subsequent hysterectomy was caused by service, or is otherwise related to an in-service injury, event, or disease. CONCLUSION OF LAW The criteria for entitlement to service connection for a hysterectomy have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1976 to May 1979 and from May 1980 to November 1981. The Veteran’s claim was previously remanded in April 2018 and February 2020. In April 2018, the Board remanded the claim for additional development including a VA examination. In February 2020, the Board determined that there had not been substantial compliance with the April 2018 Board remand. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303(a) (2019). “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 between the present disability and the disease or injury incurred or aggravated during service”- the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Certain chronic diseases, including arthritis, may be presumed to have been incurred in or aggravated by service if manifest to a compensable degree within one year of discharge from service, even though there is no evidence of such disease during service. 38 U.S.C. §§ 1101, 1112 (2012); 38 C.F.R. §§ 3.307, 3.309(a) (2019). When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. It is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility. See 38 C.F.R. § 3.102. 1. Entitlement to service connection for a hysterectomy The Veteran contends that she suffered a gynecological condition and subsequent hysterectomy that was caused by her active service. The Veteran’s service records confirm treatment for or complaint of gynecological conditions in April 1977, May 1977, October 1977, April 1978, September 1979, and May 1980. In addition, in June 1980, the Veteran was noted as having cervical dysplasia. In addition to service treatment records, the Veteran’s file contains numerous medical documents regarding her condition. The question remaining for the Board is whether the Veteran’s hysterectomy is related to her active duty service. In August 2012, a VA examiner diagnosed the Veteran with uterine fibroids, status post hysterectomy, but opined that the condition was less likely than not related to her period of service. In support of their conclusion, the examiner stated that, although the Veteran was seen on one occasion during service for complaints of bleeding after intercourse and exercise, there was no indication that the condition was chronic. The examiner also noted that the Veteran’s separation examination was silent for gynecological complaints and that there was no record of an in-service diagnosis of uterine fibroids. However, the Veteran’s service treatment records reflect that she reported pelvic or abdominal pain on more than one occasion during service, and she explained during the VA examination that her pelvic pain worsened over the years until she underwent a hysterectomy. As the examiner may not have considered the Veteran’s relevant in-service symptoms, in April 2018, the Board remanded the Veteran’s claim for additional development, including a new VA examination. The Veteran was afforded a VA examination in September 2019 for her condition. The examination was silent for any discussion on the etiology of the Veteran’s condition. As such, the Board has previously deemed this examination inadequate for appellate purposes. The Board similarly found that a September 2019 VA medical opinion was inadequate. Namely, the Board found that while the examiner provided a rationale, it was not sufficient as it did not determine whether the Veteran’s condition had its onset during active service. In March 2020, a VA examiner reviewed the Veteran’s file and provided an opinion regarding the etiology of her gynecological condition. The examiner opined that the Veteran’s condition was less likely than not incurred in or caused by an in-service injury, event, or illness. The examiner noted the Veteran’s history, including her hysterectomy in February 2003 to remove uterine fibroids and her complaints of cramps, bleeding, clotting, low back pain, and abdominal pelvic pain, and the use of birth control during service. The examiner also noted that the Veteran underwent multiple pelvic examinations during service with no evidence of uterine fibroids. In addition, he noted the Veteran’s July 1980 cervical dysplasia, explaining that this event had no bearing on uterine fibroids and was a marker of cervical cancer. The examiner explained that while the Veteran was competent to provide a history establishing chronicity and symptomatology, the Veteran was not capable of diagnosing OB/GYN conditions. The examiner also explained that following service, there was clear evidence of heavy vaginal bleeding, eventually diagnosed as dysfunction uterine bleeding due to uterine fibroids. By contrast, there was no objective evidence that the Veteran’s uterine fibroids were diagnosed or had an etiology during service. As such, the examiner determined that no medical nexus was established. The Board finds that the March 2020 VA examiner’s opinion is competent and credible as the examiner considered all relevant evidence in the claims file and provided a thorough rationale. The Board acknowledges the Veteran’s contention that the March 2020 VA opinion is not adequate. See October 2020 Appellate Brief. Nonetheless, the Board finds that the examiner carefully considered the record and drew conclusions based on the Veteran’s statements, in-service treatment records, and post-service medical documents. The examiner made notations regarding the Veteran’s in-service treatments throughout 1977, 1979, and 1980, as well as the Veteran’s lay statements. However, the examiner explained that the Veteran’s in-service notation of cervical dysplasia was not related uterine fibroids, as the two medical conditions were not related. While the Veteran argues that the examiner did not opine as to whether the fibroids were an exacerbation of irregular menses and painful periods in service, the examiner’s opinion indicates that he considered any relationship between fibroids and cervical dysplasia, as well as considered the Veteran’s documented in-service symptoms and complaints. The examiner simply did not find any relationship between the Veteran’s in-service conditions and complaints and her recent hysterectomy. As the examiner provided an adequate, detailed opinion and rationale, the opinion is afforded high probative weight regarding the issue of direct nexus between the Veteran’s hysterectomy and active duty service. With respect to the Veteran’s contention that her hysterectomy was ultimately caused by service, the preponderance of the evidence is against that claim. The March 2020 VA examiner opined that the Veteran’s gynecological condition which led to her hysterectomy was less likely than not related to service. There is no other medical evidence in the Veteran’s file to the contrary. The Board has considered the Veteran’s lay statements asserting a nexus between her gynecological condition and service. As a lay person, however, the Veteran does not have the requisite medical knowledge, training, or experience to be able to render a competent medical opinion regarding the cause of medically complex gynecological disorders. As the record does not reflect that the Veteran has such understanding or ability to relate a gynecological disability to her active service, any contention regarding the etiology of her hysterectomy does not have probative value. The Board instead places great weight upon the March 2020 VA examiner’s opinion. The medical evidence of record indicates that the Veteran’s hysterectomy is less likely than not due to service. As such, the Board finds that the preponderance of the evidence weighs against finding that the Veteran’s hysterectomy was due to her period of service. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Vosburgh, 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.