Citation Nr: 21068466 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 14-02 220 DATE: November 10, 2021 REMANDED Entitlement to service connection for a left ovarian cyst is remanded. Entitlement to service connection for endometriosis is remanded. REASONS FOR REMAND The Veteran had active duty service in the United States Navy from September 2007 to September 2011. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a January 2012 rating decision. In a December 2017 decision, the Board remanded the case to the agency of original jurisdiction (AOJ) for additional development and adjudication. The case has since been returned to the Board of appellate review. 1. Entitlement to service connection for a left ovarian cyst is remanded. 2. Entitlement to service connection for endometriosis is remanded. In response to the Board's December 2017 remand, the AOJ obtained additional VA examinations and medical opinions related to her service connection claims for endometriosis and a left ovarian cyst in January 2018. The examiner provided negative nexus opinions in relation to each claim based on her conclusion that the Veteran did not have current diagnoses for either disorder. With respect to endometriosis, the examiner stated that she had reviewed the claims file and was unable to locate an operative note or pathology demonstrating laparoscopy. The examiner observed that the Veteran had stated that she did not have surgery for endometriosis, and the Veteran had a cesarean section for both deliveries as confirmed in her files. The examiner concluded that the Veteran's pelvic pain differential diagnosis was extensive; therefore, rendering a diagnosis would preclude an appropriate medical workup and indirect the Veteran to the best possible care for the diagnosis. Therefore, it was less likely than not that the Veteran had a diagnosis of endometriosis without a confirmatory biopsy or laparoscopy. With respect to the left ovarian cyst, the examiner stated that she had reviewed the claims file and the left ovarian cyst of June 2011 had resolved, and it was evident on a September 2015 CT scan. Therefore, the pelvic pain was less likely than not secondary to the left ovarian cyst of June 2011. The AOJ subsequently readjudicated the issues on appeal in an August 2019 Supplemental Statement of the Case (SSOC). The record reflects that after the appeal was transferred to the Board in September 2019, a September 2019 VA examination specific to posttraumatic stress disorder (PTSD) was associated with the claims file in October 2019. The examiner noted in the report that medical diagnoses relevant to the understanding or management of the Veteran's mental health disorder included endometriosis with pelvic pain and ovarian cysts. As this report relates to the question of whether the Veteran has current diagnoses for the disorders at issue, it is relevant to her service connection claims. In a January 2020 letter, the Board notified the Veteran that new evidence was added to the claims file after the August 2019 SSOC that was not previously considered by the AOJ. The Board requested for the Veteran to provide a waiver of her right to have the AOJ initially review this additional evidence. In February 2020, the Board received the Veteran's January 2020 response requesting for the Board to remand her case back to the AOJ for the review of the additional evidence. Accordingly, the Board finds that remand is required. See 38 C.F.R. § 20.1305(c). The Board also finds that additional medical opinions should be obtained on remand. Regarding the January 2018 VA medical opinion that addressed the left ovarian cyst, it is unclear from the examiner's opinion whether the now resolved left ovarian cyst was present at any point during the current appeal period. For purposes of establishing service connection, a "current disability" includes a disability which existed at the time a claim for VA disability compensation is filed or during the pendency of the claim, even if that disability is currently in remission or has completely resolved. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Board consequently finds that a remand is necessary to obtain a VA medical opinion that addresses this question. Regarding the January 2018 VA medical opinion that addressed endometriosis, the Board finds that it is also unclear whether any pain symptoms associated with this claimed disorder cause functional impairment of earning capacity such that they could constitute a current disability. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). In this regard, the Board notes that a subsequent November 2020 VA treatment record stated that the Veteran had a history of chronic lower abdominal endometriosis pain before noting an assessment of endometriosis/chronic pain. The Board also acknowledges that the Board previously denied entitlement to service connection for pelvic pain in the December 2017 decision. The Board found in part that the Veteran was not diagnosed with any underlying pathology related to her pelvic pain apart from her left ovarian cyst and endometriosis symptoms. Given the vague characterization of that claim and the fact that the Board appeared to acknowledge that the pain was encompassed by the separately claimed endometriosis, the Board finds that the lower abdominal pain related to the claimed endometriosis is separate and distinguishable from the service connection claim for pelvic pain that was denied in the December 2017 Board decision. See Boggs v. Peake, 520 F.3d 1330 (Fed. Cir. 2008) (claims based on separate and distinctly diagnosed disorders must be considered separate and distinct claims for purposes of VA benefits). Based on the foregoing, an additional medical opinion should be obtained that clarifies whether the Veteran has a current diagnosis of endometriosis or related lower abdominal pain that causes a functional impairment of earning capacity. The Board notes that the January 2018 VA examiner also appeared to reference the Veteran's history of cesarean sections in relation to her pain. As the Veteran is already service-connected for "painful scar, cesarean section," the examiner should additionally address whether any current lower abdominal pain is separate and distinct from symptoms attributable to this disability. The matters are REMANDED for the following action: 1. The AOJ should request that the Veteran provide the names and addresses of any health care providers who have provided treatment for her claimed endometriosis and left ovarian cyst. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. The AOJ should also secure any outstanding VA medical records, to include records dated since August 2021. 2. After completing the preceding development in paragraph 1, obtain a VA medical opinion from a qualified examiner that addresses the Veteran's service connection claim for endometriosis. The claims file must be made available to the examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions. A clear explanation for all opinions based on specific facts for the case as well as relevant medical principles is needed. If an examination is deemed necessary, one must be provided. The Veteran is competent to attest to matters of which she has first-hand knowledge, including observable symptoms. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should state whether the Veteran has a current diagnosis of endometriosis. If a diagnosis for endometriosis is not found, the examiner should state whether the Veteran experiences any lower abdominal pain symptoms that are separate and distinct from her service-connected "painful scar, cesarean section," that cause functional impairment of earning capacity. If an endometriosis diagnosis and/or lower abdominal pain causing functional impairment in earning capacity separate and distinct from the service-connected painful scar, cesarean section, is identified, the examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the disorder manifested during, or is otherwise related to, the Veteran's active service. 3. After completing the preceding development in paragraph 1, obtain a VA medical opinion from a qualified examiner that addresses the etiology of any current left ovarian cyst. The claims file must be made available to the examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions. A clear explanation for all opinions based on specific facts for the case as well as relevant medical principles is needed. If an examination is deemed necessary, one must be provided. The Veteran is competent to attest to matters of which she has first-hand knowledge, including observable symptoms. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should clarify whether the left ovarian cyst noted in June 2011 has been present during the appeal period (since September 2011) or within close proximity thereto (even if it has since resolved). If a disorder during the appeal period is identified, the examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the disorder manifested during, or is otherwise related to, the Veteran's active service. 4. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. If the benefit sought is not granted to the Veteran's satisfaction, send the Veteran and her representative a supplemental statement of the case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. GAYLE STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.C. Spragins, 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.