Citation Nr: 21004548 Decision Date: 01/27/21 Archive Date: 01/27/21 DOCKET NO. 16-02 871 DATE: January 27, 2021 ORDER Entitlement to service connection for laparoscopic vaginal hysterectomy, to include due to fibroids and cervical dysplasia, is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s laparoscopic vaginal hysterectomy is related to an in-service event, injury, or disease. CONCLUSION OF LAW The criteria for service connection for laparoscopic vaginal hysterectomy are not 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 March 1995 until December 2000 and from May 2003 until April 2004, with additional service in the Reserve. In May 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. This matter was previously before the Board in July 2020 when it was remanded to obtain an addendum opinion. The Board finds there has been substantial compliance with its previous remand directives and will proceed to adjudication. Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for laparoscopic vaginal hysterectomy, to include due to fibroids and cervical dysplasia The Veteran contends that her laparoscopic vaginal hysterectomy is etiologically related to service, including due to fibroids and cervical dysplasia and scarring due to related treatment for those conditions. For the reasons described below, the Board concludes the preponderance of the evidence is against the claim and entitlement to service connection for laparoscopic vaginal hysterectomy is denied. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a link between the claimed in-service disease or injury and the present disability. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). The question before the Board is whether the Veteran’s post-service laparoscopic vaginal hysterectomy is etiologically related to service to include as due to fibroids and cervical dysplasia. A review of the Veteran’s service treatment records (STRs) show that she underwent a loop electrosurgical excision procedure (LEEP) in March 1997 and in February 2004 to treat mild and moderate dysplasia of the cervix. An April 1997 letter from Dr. P.K., M.D., stated that moderate dysplasia was found in February 1997 and the Veteran underwent a LEEP in March 1997. Medical records from Presbyterian Hospital show a DaVinci total laparoscopic hysterectomy was performed on the Veteran in September 2012, after service. Both the pre-operative and post-operative diagnoses for that procedure were menorrhagia. In June 2015, the Veteran was provided a VA medical examination in connection with the claim. The examiner diagnosed the Veteran with laparoscopic vaginal hysterectomy for menorrhagia due to fibroids and cervical dysplasia s/p LEEP. The examiner concluded that the Veteran no longer has a cervix, but that cervical dysplasia was at least as likely as not incurred during service. The examiner further opined that the Veteran’s hysterectomy was done for menorrhagia due to uterine fibroids diagnosed in 2012. Additionally, the examiner opined that cervical dysplasia is not a cause of uterine fibroids and that the conditions are unrelated. The examiner concluded the Veteran’s menorrhagia due to uterine fibroids resulting in vaginal hysterectomy is less likely than not related to her cervical dysplasia. At the May 2019 Board hearing, the Veteran testified she saw a gynecologist during service who said that “because of the heavy bleeding and the fibroids that I was having and the pain that I was having monthly with my menses, he requested that I have the hysterectomy.” The Veteran further testified that two doctors – her gynecologist in Tucson (now deceased) and the surgeon at Presbyterian Hospital – told her that she had a lot of scarring on her cervix due to the LEEPs that caused her to have a hysterectomy. An addendum VA medical opinion was obtained in September 2020 to determine the likely etiology of the Veteran’s hysterectomy to include as due to scarring from LEEPs conducted during active service. The examiner noted diagnoses of cervical dysplasia, fibroids, and status post laparoscopic vaginal hysterectomy and opined that the Veteran’s “hysterectomy was less likely than not incurred in or caused by cervical scarring from previous LEEP procedures which were incurred in active service…” The opinion provider’s rationale was that the September 2012 surgical note lists the pre-operative diagnosis as menorrhagia and that menorrhagia was caused by her diagnosis of uterine fibroids in 2012. The opinion provider concluded their opinion by stating a LEEP procedure is not an indication for a hysterectomy. The Board finds that the June 2015 and September 2020 VA medical examinations, when taken together, are of substantial probative value given the examiners’ review of the record and the Veteran’s history. The examiners relied on their medical expertise and training in opining that the Veteran’s laparoscopic vaginal hysterectomy is not related to her service. Although the Veteran is competent to testify to what she was told by physicians in the bases of their conclusions, as communicated by the Veteran, and whether or not they had the ability to review the Veteran’s medical and service history are not known. For these reasons, the opinions of these physicians are assigned little probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). While the Board understands it is the Veteran’s sincere belief that her hysterectomy is the result of cervical scarring caused by in-service LEEPs, the question of nexus is a complex medical determination that goes beyond a simple and immediately observable cause-and-effect relationship. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). For this reason, the Veteran is not competent to establish a connection between her cervical scaring and hysterectomy. The Board concludes that the most probative evidence of record shows that the Veteran’s laparoscopic vaginal hysterectomy is not related to her military service. The preponderance of the evidence is against the claim for service connection and the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). (Continued on the next page)   Service connection is denied. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.D. Collins, 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.