Citation Nr: 21067955 Decision Date: 11/08/21 Archive Date: 11/08/21 DOCKET NO. 16-24 692A DATE: November 8, 2021 REMANDED Entitlement to service connection for a gynecological disorder other than menorrhagia, to include disordered proliferative endometrium, uterine fibroids, and/or uterine polyps, and residuals of hysterectomy, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from December 1990 to August 1991, with service in the Southwest Asia Theater of Operations during the Persian Gulf War from February 1991 to May 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board and remanded for additional development in September 2020 and April 2021. The Veteran contends that her gynecological disorder, to include disordered proliferative endometrium, uterine fibroids, and/or uterine polyps and residuals of hysterectomy, is related to service. A September 2021 rating decision granted service connection for menorrhagia based on a June 2021 VA medical opinion finding that the Veteran's vaginal bleeding in 1992 was at least as likely as not due to the stress of deployment. However, the medical opinion did not find a relationship between other gynecological disorders and service, and did not specifically address whether there was a relationship between the menorrhagia and other gynecological disorders. As such, it remains at issue whether a separate gynecological disorder, to include disordered proliferative endometrium, uterine fibroids, and/or uterine polyps and residuals of hysterectomy, is related to service. The Board sincerely regrets the further delay, but finds that a remand is necessary in this appeal to provide the Veteran full consideration of her claim. During the pendency of the appeal, the Veteran was granted service connection for vaginal bleeding, based on a finding that it began during service and is related to her current menorrhagia. The Board finds that, based on such finding, along with assertions that her gynecological conditions are interrelated, an opinion on secondary service connection is necessary prior to adjudication of the remaining issues on appeal. Specifically, an additional opinion is needed to determine whether the Veteran's gynecological disorders other than menorrhagia, to include disordered proliferative endometrium, uterine fibroids, and/or uterine polyps and residuals of hysterectomy, are secondary to service-connected menorrhagia or related to service. Accordingly, the matter is REMANDED for the following action: 1. Obtain an opinion from a qualified clinician to determine the nature and etiology of the Veteran's gynecological disorders other than menorrhagia, to include disordered proliferative endometrium, uterine fibroids, and/or uterine polyps and residuals of hysterectomy. The evidentiary record, including a copy of this remand, must be made available to and be reviewed by the clinician. It is up to the discretion of the reviewing clinician as to whether an examination is necessary to provide adequate opinions. After the record review and examination of the Veteran, if deemed necessary, the reviewing clinician is asked to respond to the following inquiries: (a) Is it at least as likely as not that the Veteran's gynecological disorder, to include disordered proliferative endometrium, uterine fibroids, and/or uterine polyps and residuals of hysterectomy, is aggravated beyond its natural progression by service-connected menorrhagia? (b) Is it at least as likely as not that the Veteran's gynecological disorder, to include disordered proliferative endometrium, uterine fibroids, and/or uterine polyps and residuals of hysterectomy, is proximately due to or a result of service-connected menorrhagia? (c) Is it at least as likely as not that the Veteran's gynecological disorder other than menorrhagia, to include disordered proliferative endometrium, uterine fibroids, and/or uterine polyps and residuals of hysterectomy, is related to an in-service injury, disease, or event? The examiner should consider the noted 1991 outpatient uterine scar tissue procedure, the report of right ovarian pain during deployment, and any relation to the later diagnosed disorders of disordered proliferative endometrium, uterine fibroids, and uterine polyps. (d) For any diagnosed gynecological disorder other than menorrhagia, is the etiology or pathophysiology of the condition not understood at all as to this particular Veteran? In rendering the opinions above, the reviewing clinician is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the reviewing clinician rejects the Veteran's reports, he or she must provide an explanation for such rejection. The reviewing clinician is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. A complete rationale for the opinion should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the reviewing clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the reviewing clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). (Continued on the next page) 2. Thereafter, readjudicate the claim. If any benefit sought remains denied, provide the Veteran and her representative with a supplemental statement of the case (SSOC), and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Wilson, 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.