Citation Nr: 21062653 Decision Date: 10/08/21 Archive Date: 10/08/21 DOCKET NO. 12-13 349 DATE: October 8, 2021 REMANDED Entitlement to service connection for a uterine condition is remanded. Entitlement to service connection for an ovarian condition is remanded. REASONS FOR REMAND The Veteran served on active duty from January 2009 to April 2009. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2010 rating decision. In October 2016, the Veteran appeared at hearing before the undersigned Veterans Law Judge with regard to these claims via video conference from St. Paul, Minnesota. A transcript of the hearing has been associated with the electronic file. The Board last remanded these matters for additional development in March 2020. Unfortunately, the Board finds that another remand is warranted given the inadequate medical opinion on record. 1. Entitlement to service connection for a uterine condition is remanded. 2. Entitlement to service connection for an ovarian condition is remanded. The Veteran asserts that she incurred uterine and ovarian tumors during her service and filed a claim for compensation within the presumptive period. See VA 21-4138 Statement in Support of Claim received 4/19/2010 at page 1. Alternatively, the Veteran has claimed that her uterine and ovarian condition is related to inservice assaults. See Hearing Transcript received 10/13/2016 at page 10. Specifically, she stated that her uterine and ovarian problem began after the alleged in-service assaults. Further, the Veteran states that while in service she had heavy bleeding for six weeks. Id. In the March 2020 Board decision, these matters were remanded for a new VA examination and medical opinion. Although the Veteran received a new VA examination in October 2020, the Board finds that the medical opinion on direct service connection is inadequate. Specifically, the VA examiner found the Veteran's ovarian condition diagnosed as an ovarian cyst was less likely than not incurred in active duty because there was no evaluation or complaint of prolonged menstrual bleeding. Although the examiner acknowledged that the Veteran visited the ER in January and February 2009, he found that there was no gynecological complaint or diagnosis on those visits. See C&P Exam received 10/14/2020 at page 3. Since the record contains a provisional diagnosis in February 2009 of irregular periods and a referral to be evaluated for a gynecological disorder, the Board finds that the opinion is based on an incorrect factual premise. See STR- Medical received 11/16/2016; see also Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (stating that a medical opinion based on an inaccurate factual premise has no probative value.); see Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012) ("If the opinion is based on an inaccurate factual premise, then it is correct to discount it entirely."). Although an addendum opinion was submitted from the same VA examiner in November 2020, the Board finds that the aforementioned treatment and diagnosis of irregular periods was not acknowledged or discussed in the new opinion. See C&P Exam received 11/05/2020. Further, the occurrence of irregular periods is significant since the Veteran has a current diagnosis of endometrial polyp with irregular menstrual bleeding per the October 2020 VA examination. See C&P Exam received 10/14/2020 at page 2. In the remand, the Board directed that the VA examiner also provide medical opinions on secondary service connection and aggravation. The October 2020 VA medical opinions on secondary service connection and aggravation of a non service-connected condition by a service-connected condition are acknowledged. Therefore, on remand the Board will direct a new VA examination and medical opinion only for direct service connection. These matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination with a different examiner for her uterine condition and ovarian condition. The examiner must review the claims file. The record shows that the Veteran has been diagnosed with endometrial polyp with irregular menstrual bleeding and a left ovarian cyst. See C&P Exam received 10/14/2020 at page 2. The examiner is asked to provide a response to the following: (a) Is any diagnosed uterine condition to include endometrial polyp with irregular menstrual bleeding at least as likely as not related to service, including the provisional diagnosis of irregular menstrual bleeding in February 2009? See STR- Medical received 11/16/2016. (b) Is any diagnosed ovarian condition to include left ovarian cyst at least as likely as not related to service, including the provisional diagnosis of irregular menstrual bleeding in February 2009? See STR- Medical received 11/16/2016. The examiner must provide a complete rationale for his or her opinions in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. In providing the requested opinion, consider the Veteran's description of her in-service injury and symptoms as well as her post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of her current disability, this should be noted. Stated another way, do the Veteran's reports about her symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Dixon, 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.