Citation Nr: 21070227 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 17-27 018 DATE: November 23, 2021 ORDER Entitlement to an initial rating of 10 percent, but not higher, for the entire period on appeal for endometriosis is granted. FINDING OF FACT Throughout the period on appeal, the Veteran's service-connected endometriosis disability has presented with pelvic pain requiring continuous treatment. CONCLUSION OF LAW The criteria for the assignment of an initial 10 percent rating, but not higher, for endometriosis have been met for the entire period on appeal. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. § 4.116, Diagnostic Code 7629 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from September 1991 to September 1994. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office. In August 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge. In November 2019 and June 2021, this issue was remanded by the Board for further development. The case has now been returned to the Board for further appellate action. Increased Ratings Endometriosis The Veteran contends that she is entitled to a higher rating for her service-connected endometriosis disability. She is currently in receipt of a 10 percent rating, as of March 17, 2020, with an initial noncompensable (zero) percent rating, prior thereto. During the Veteran's August 2019 hearing before the Board, she testified that although her symptom of bleeding stopped after her partial hysterectomy, she continued to experience pain. She treated her symptoms with pain medicine and the use of ice packs. She also testified that she experiences incontinence and that she believes the use of pain medicine caused constipation. The March 2020 VA examination confirmed a diagnosis of endometriosis. The Veteran reported constant, chronic pelvic and hip pain, however, the report also indicated that at the time of the in-person examination, there were no current symptoms. Overall, the examiner found that the Veteran's pelvic pain required continuous treatment. The Veteran submitted to another VA examination in July 2021. The examiner again confirmed the diagnosis of endometriosis as well as noted that the Veteran underwent a partial hysterectomy in 2010. At the time of the examination, the Veteran reported lower abdominal cramping and sharp pain emanating down her leg. The examiner found that the Veteran was experiencing current symptoms of intermittent moderate pain and pelvic pressure. Notably, however, the examiner found that such symptoms did not require continuous treatment. It was additionally confirmed that the Veteran experiences incontinence which does not require the use of absorbent material. The examiner did not, however, specifically attribute the symptom to the Veteran's endometriosis, but rather, noted the cause as "unknown." Ongoing VA treatment records reflect that the Veteran has consistently reported experiencing pelvic pain. Of specific note is a July 2017 record following up on her reports of experiencing pain, indicating that the symptom had worsened. Most recently, a July 2021 record depicts that the Veteran described her pain as an intermittent ache most of the time, with a sharp pain that lasts for about 1 to 2 minutes. The Veteran reported taking Tylenol or tramadol if she had it available to treat her pain and stated that the pain occurs almost every day. In addition to the above, the Veteran submitted on-line articles which discuss the symptoms and treatment for endometriosis. While the Board has considered this additional evidence as part of the claims file, it is of little probative value in addressing the issue at hand as it is not evidence of the Veteran's personal symptoms or severity thereof. Examination of the Veteran has not demonstrated that she suffers from lesions involving the bowel or bladder. Moreover, she has personally confirmed throughout her own reporting, and in testimony before the Board, that she does not experience bleeding. In analyzing the cumulative evidence of record, the Board finds that it is at least in relative equipoise as to the severity of the Veteran's endometriosis disability for the period on appeal prior to March 17, 2020. During the Veteran's ongoing treatment, she reported a worsening of her symptoms and reported treating her pain with over-the-counter medicine. Thus, resolving reasonable doubt in the Veteran's favor, the Board finds that the Veteran has experienced pelvic pain requiring continuous treatment throughout the period on appeal, thus warranting a 10 percent rating. The Board also finds that a higher rating for endometriosis for the entire period on appeal is not warranted. As discussed above, most recently, the Veteran has continued to treat her intermittent pain, which occurs almost daily, with over-the-counter medicine. There is no evidence that her self-treated pain-management results in uncontrolled symptoms. To the contrary, throughout her medical treatment records it is demonstrated that she has declined any further examination of her condition to determine its severity. Nevertheless, the Veteran is considered competent to report her symptoms of pain as they are within the realm of her personal experience and are capable of lay observation. See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994) (a layperson is competent to report on that of which he or she has personal knowledge). Thus, the Board considers her reporting in this regard credible as it has been consistent throughout the period on appeal. Taking the Veteran's assertions in consideration along with the highly probative medical findings of record, the Board finds that the preponderance of the evidence is against the claim for a rating in excess of 10 percent for the service-connected endometriosis disability throughout the period on appeal. As there is no doubt to be resolved, a higher rating is denied. 38 U.S.C. § 5107(b) (2018); 38 C.F.R. §§ 3.102, 4.3, 4.59 (2021); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Sutherell, 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.