Citation Nr: 21064098 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 13-16 189 DATE: October 19, 2021 ORDER Entitlement to a compensable rating for service-connected fibroids is denied. FINDING OF FACT For the entire period on appeal, the Veteran's service-connected fibroids did not require continuous treatment. CONCLUSION OF LAW The criteria for a compensable rating for fibroids are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.116, DC 7613. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from August 1997 to April 2009, to include 5 years of foreign service. For her meritorious service, the Veteran was awarded (among other decorations) the Army Commendation Medal and the Army Achievement Medal. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in November 2009 by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded by the Board in April 2018, August 2019, November 2020, and May 2021 for additional development. The development ordered by the Board, to include obtaining private and VA treatment records, and to obtain adequate opinions. As reflected below, that development has been completed, and the Board finds substantial compliance with its previous remand instructions. 1. Entitlement to a compensable rating for service connected fibroids The Veteran asserts that she is entitled to a compensable rating for her uterine fibroids. Disability ratings are determined by the applications of the VA's Schedule for Rating Disabilities. 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; Mauerhan v. Principi, 16 Vet. App. 436. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Fibroids are rated under Diagnostic Code (DC) 7613 pursuant to the General Rating Formula for Gynecological Conditions and Disorders of the Breast. Under DC 7613, for "disease, injury, or adhesions of" the uterus, a noncompensable disability rating is warranted for symptoms that do not require continuous treatment; a 10 percent disability rating is awarded for symptoms that require continuous treatment; and a maximum schedular 30 percent rating is awarded when symptoms are not controlled by continuous treatment. The Veteran submitted a notice of disagreement in July 2010. On her notice, she stated that she is taking prescription medication for her fibroids which cause her pain before, during, and after her menstrual cycle as well as heavy bleeding. VA treatment records from November 2008 to March 2011 document treatment for premenstrual and postmenstrual pain. A pelvic ultrasound in November 2008 revealed a calcified fibroid. Another pelvic ultrasound conducted in October 2010 documented multiple small fibroids. She was prescribed medications to take at the onset of symptoms. A radiologist report in March 2011 also reported multiple small fibroids in the uterus. Private treatment records from Dr. Chambers in June 2011 also document a laparoscopy performed due to complaints of chronic pelvic pain. The laparoscopy revealed that the Veteran had, what Dr. Chambers referred to as, suspected adenomyosis. Records from June 2011 also note that the Veteran was taking medications for pain (which also included pain due to a back disability and migraines). The Veteran appeared for a VA examination in February 2012. During the examination, the Veteran reported cramping, dull and sharp pains, and long lasting pain. Other symptoms included pelvic pain and heavy menstrual bleeding. The Veteran also reported having her uterus completely removed in August 2011. The Veteran underwent another VA examination for gynecological conditions in September 2012. It was noted that the Veteran had a laparoscopic hysterectomy for adenomyosis in July 2011. The Veteran reported symptoms of pain and abdominal cramping and that she was currently on Levsin for treatment. The examiner reported that the Veteran's abdominal cramping required continuous treatment. The September 2012 VA examination was subsequently found to be insufficient in the April 2018 Board remand due to a contradicting medical rationale. A VA examination conducted in March 2013 confirmed a diagnosis of fibroids. The Veteran's symptoms were reported as cramping in the lower abdomen, pain, and pelvic pressure. The examiner determined that the Veteran did not have treatment for her reproductive tract conditions and did not currently require treatment or medications for symptoms related to reproductive tract conditions. The Board subsequently found the March 2013 examination to be insufficient in the April 2018 remand. This was largely in part due to the examiner finding that the Veteran did not receive treatment for her reproductive tract conditions although her medical record documents treatment, to include a partial hysterectomy. Pursuant to April 2018 and August 2019 Board remands, the Veteran underwent a new VA examination in November 2019. The examiner reported that the Veteran's condition began in 2000 with severe cramping and stabbing pain. The examiner stated that the Veteran was evaluated and encouraged to take pain medications. The pain however, persisted and the Veteran underwent a supracervical hysterectomy. The examiner then noted that the Veteran currently has occasional abdominal pain. The examiner reported that the Veteran does not currently require treatment for symptoms related to reproductive tract conditions. Upon evaluation and review of the available records, the examiner determined that the Veteran did not have fibroids and instead determined that the Veteran had nabothian cysts of the endocervix and chronic pelvic pain. The examiner explained that the Veteran had been treated for fibroids in 2008 and stated that multiple fibroids were found in the uterus in 2010; however, her surgical pathology report for her July 2011 hysterectomy found nabothian cysts of the endocervix. No fibroids were noted per surgical pathology. In the November 2020 Board remand, the Board found the November 2019 VA examination to be insufficient. The Board found that the examiner did not discuss the previous treatment that the Veteran had received for her fibroids throughout her medical record. Further the examiner also did not provide supporting rationale for the conclusion reached and also did not address whether the Veteran required continuous treatment for her abdominal cramping. Pursuant to the November 2020 Board remand, the Veteran appeared for another VA examination in March 2021. The examiner noted the diagnosis to be fibroids. Current symptoms were reported as mild pain, intermittent pain, and occasional pain during intercourse. The examiner determined that the Veteran did not currently require treatment for symptoms related to reproductive tract conditions. Upon reviewing all of the pertinent evidence of record, the Board finds that entitlement to a compensable rating for service-connected fibroids is not warranted. In this regard, the medical evidence of record documents that the Veteran complained of heavy menstrual bleeding as well as pelvic pain and received treatment for said symptoms. However, medications prescribed to the Veteran were for her to take as needed and did not require her to take them continuously. Additionally, records show that the Veteran had her uterus removed in July 2011 due to adenomyosis. Since then, the Veteran still experienced symptoms of abdominal cramping. The September 2012 VA examiner determined that the abdominal cramping required continuous treatment; however, did not determine that the Veteran needed continuous treatment for her fibroids. Further, the November 2019 and March 2021 VA examiners determined that the Veteran's reproductive tract conditions currently do not require treatment. In sum, although there is medical evidence of record documenting treatment for the Veteran's fibroids, there is no indication that this treatment was continuous. Instead, the Veteran's treatment was noted to be on an as needed basis. As such, entitlement to a compensable disability rating for her service-connected fibroids is not warranted. Finally, the Board finds that the Veteran's hysterectomy was not due to her service-connected fibroid disorder. After laying out the history of the Veteran's disability, including through medical records and the Veteran's statements, the examiner determined that the Veteran's hysterectomy was unrelated to her service-connected disability. Specifically, the VA examiner noted that, at the time of her hysterectomy, the operative and pathology reports were silent for fibroid conditions. While this case has a history of incomplete opinions, the Board finds the opinions and examinations it has relied upon in this decision to be adequate. Notably, these more recent opinions reflect in-depth review of the Veteran's claims file, contain specific findings required to properly rate the Veteran under the applicable Diagnostic Codes, and contain well-reasoned rationales for all opinions. In reaching such decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran's claims for a compensable rating for fibroids. As such, that doctrine is not applicable in the instant appeal, and her claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. K. Hall, 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.