Citation Nr: 21004127 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 12-12 586 DATE: January 26, 2021 ORDER Entitlement to service connection for a gynecological disability is denied. FINDING OF FACT The Veteran does not have a gynecological disability. CONCLUSION OF LAW The criteria for entitlement to service connection for a gynecological disability have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from January 1981 to December 1983 and November 2001 to November 2002, with additional service in the Army Reserve National Guard. The Board sincerely thanks the Veteran for her service to our country. This matter comes before the Board of Veterans’ Appeals (Board) from a December 2008 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The claim was previously before the Board in March 2019 and August 2019, when it was remanded for additional development. The Board finds that there has been substantial compliance with its remand directives. 1. Entitlement to service connection for a gynecological disability The Veteran contends that she has a gynecological disorder that was incurred in service. Alternatively, she contends that her pelvic pain is due to her service connected back disability. See December 2020 Informal Hearing Presentation. Service connection may be granted for disability due to disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. 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. To substantiate a claim of service connection, there must be evidence of: (1) a current disability; (2) a disease, injury, or event in service; and (3) a nexus or causal relationship between the claimed disability and the disease, injury, or event in service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be established on a secondary basis for a disability that is proximately due to, the result of, or aggravated by a service-connected or injury. Establishment of secondary service connection requires: (1) evidence of a current disability for which secondary service connection is sought; (2) a disability which is service connected; and (3) competent evidence of a nexus between the two. 38 C.F.R. § 3.310 (a); see also Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). Decisions of the Board shall consider all information and lay and medical evidence of record in a case. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.303(a). Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a layperson. 38 C.F.R. § 3.159(a)(2). Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. 38 C.F.R. § 3.159(a)(1). It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case, with all reasonable doubt to be resolved in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55(1990). Records from the Veteran’s December 1982 ganglion cyst excision show that the Veteran reported her ovaries were swollen, but that no exploratory laparoscopy was performed. In addition, a July 1999 ultrasound of the pelvis revealed a retroverted uterus, but unremarkable ovaries. An October 2009 gynecology visit note at a VA medical center shows that the Veteran similarly reported a history of pelvic pain and “swelling” of the ovaries. In a May 2019 statement in support of claim, the Veteran explained that her pelvic pain comes and goes, and by the time she gets scheduled for an evaluation, her ovary is normal and the pain has stopped. Nevertheless, she reported the onset of pain while on active duty, and that the pain has recurred since then, even during her time in the reserves. The Board concludes that the Veteran does not have any current disability associated with her complaints of pelvic pain and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Veteran has consistently reported flare-ups of pelvic pain since service. The Veteran is competent to report the symptoms she experiences. In so far as the Veteran has complained of pain in connection with a claimed gynecological disability, the Board recognizes the Court's decision in Saunders v. Wilkie, 886 F.3d 1356 (2018), that "pain alone can serve as a functional impairment and therefore qualify as a disability." However, the Court in Saunders cautioned that a Veteran cannot demonstrate service connection simply by asserting subjective pain. Id. Rather, the Court stated "[t]o establish the presence of a disability, the Veteran will need to show that [his] pain reaches the level of functional impairment of earning capacity." Id. Here, the preponderance of the evidence of record is against a finding that her pain reaches functional impairment of earning capacity. The March 2020 VA examiner opined that the claimed condition is less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examination report shows a diagnosis of pelvic pain of unknown origin. The examiner stated that a February 2020 pelvis CT was normal. The examiner detailed that there was pelvic pain noted during service that was attributable to an ovarian cyst, but that, as shown in the February 2020 imaging, the condition no longer exists. The examiner cited a February 2019 well woman examination showing that the Veteran had no complaints. The examiner noted the Veteran’s history of chronic low back pain and suggested that her pelvic pain may be referred pain from the back. The examiner considered that Veteran’s VA treatment records, current evaluation, and reported pelvic pain consisting of infrequent episode lasting approximately 30 seconds and stated that there is no functional loss due to the Veteran’s pelvic pain. The examiner stated that no gynecologic condition exists and opined that it is less likely than not that the pelvic pain described is the same as that described during service. The Board affords the March 2020 VA examination high probative value because it considers the Veteran’s medical history, lay statements regarding symptomatology, and provides a full rationale for the opinion. The Board has considered the Veteran’s argument that the March 2020 examiner’s opinion suggests that the Veteran’s pelvic pain is secondary to her service-connected low back disorder. However, the Board notes that pain due to the Veteran’s back disability is already contemplated by her disability rating under Diagnostic Code 5241 (previously evaluated under Diagnostic Code 5237). Further, the Veteran has not been diagnosed with a current gynecological or pelvic disability. In the absence of a current disability, service connection is not warranted. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143-144 (1992). Accordingly, the Board finds that the preponderance of the evidence is against the Veteran's claims of service connection for a gynecological disability; therefore, the benefit of the doubt rule does not apply and the appeal as to this matter must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board O. Halpern 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.