Citation Nr: 21075105 Decision Date: 12/17/21 Archive Date: 12/17/21 DOCKET NO. 17-59 108 DATE: December 17, 2021 ORDER Entitlement to service connection for endometriosis is granted. REMANDED Entitlement to service connection for chronic fatigue syndrome, claimed as secondary to endometriosis, is remanded. Entitlement to service connection for osteopenia of the left femoral neck, claimed as secondary to endometriosis, is remanded. Entitlement to service connection for osteopenia of the lumbar spine, claimed as secondary to endometriosis, is remanded. Entitlement to service connection for colon surgery, claimed as secondary to endometriosis, is remanded. Entitlement to service connection for an appendectomy, claimed as secondary to endometriosis, is remanded. Entitlement to service connection for left lapingo-oophroectomy, claimed as secondary to endometriosis, is remanded. Entitlement to service connection for a hysterectomy, claimed as secondary to endometriosis, is remanded. Entitlement to service connection for infertility, claimed as secondary to endometriosis, is remanded. FINDING OF FACT Giving the Veteran the benefit of the doubt, her endometriosis began during active service. CONCLUSION OF LAW Giving the Veteran the benefit of the doubt, the criteria for service connection for endometriosis are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1976 to May 1983. This matter is on appeal from a December 2013 rating decision. In July 2021, the Veteran had a hearing before the undersigned Veterans Law Judge. 1. Entitlement to service connection for endometriosis. The Veteran asserts that she had endometriosis prior to service that was worsened by service, including due to claimed in-service toxin exposure, that endometriosis began during service, or that endometriosis was caused by claimed in-service toxin exposure. Giving the Veteran the benefit of the doubt, the Board concludes that the Veteran has a current disability that began during active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). A June 2014 VA medical record and October 2013 VA examination show the Veteran has a current diagnosis of endometriosis. Thus, the question becomes whether the current disability is related to service. On this question there is probative evidence in favor of and against the claim. The evidence against the claim includes that the Veteran was not diagnosed with endometriosis during her service. Following her May 1983 separation from service, however, an August 1986 operation report found left endometrioma. Although there is an October 2013 VA examination of record, the VA examiner did not provide any medical opinions as to causation or timing of the endometriosis. The evidence in favor of the claim includes a June 2014 letter from the Veteran's physician Dr. V.W. that indicated that the Veteran's endometriosis symptoms started while she was in service, noting abnormal endometriosis cells growing on her cervix in November 1981. She also noted the Veteran's later exploratory surgery that found a ruptured left ovary. She explained that the binding effect of the abnormal tissues caused by endometriosis resulted in endo tissue wrapping around the Veteran's left ovary. In an August 2021 opinion, private medical opinion provider Dr. M.L. reported that although the Veteran did not have a formal diagnosis until 1986, three years after service due to ovary rupture, endometriosis is slow-growing and difficult to diagnose with a medical diagnosis often not made for eight to ten years. He found that endometriosis began to cause symptoms in 1979 and continued to the present. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current endometriosis arose during service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for endometriosis is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND The claims for entitlement to service connection, claimed as secondary to endometriosis, for (1) chronic fatigue syndrome, (2) osteopenia of the left femoral neck, (3) osteopenia of the lumbar spine, (4) colon surgery, (5) an appendectomy, (6) left lapingo-oophroectomy, (7) a hysterectomy, and (8) infertility are remanded. The Veteran claims that the claimed disorders developed secondary to her endometriosis. As the Board has granted the endometriosis claim, the Agency of Original Jurisdiction (AOJ) should be given the opportunity to consider these claims on a secondary basis. The Veteran has indicated that there were post-service federal records of treatment, including Lackland Air Force Base and Walter Reed Army Medical Center, including records under her former married names (indicated in a July 2015 correspondence). The Veteran has also submitted records from some of these facilities. The AOJ should have the Veteran clarify whether there are additional records that need to be obtained or if she has already submitted all records from these facilities. The Veteran should also clarify if there would be any records with the Social Security Administration (SSA). If there are outstanding records, those records should be obtained. The Board cannot make a fully-informed decision on the service connection issues because no VA examiner has opined whether the claimed disorders developed due to the service-connected endometriosis. The matters are REMANDED for the following actions: 1. Have the Veteran clarify whether she believes there are additional post-service federal records (to include SSA records) that she has not provided or should be obtained by the AOJ, to include records under her former married names. If any records are identified, the AOJ should document all requests for information as well as all responses in the claims file. 2. After the above record development has been accomplished, obtain a VA medical opinion regarding whether the Veteran's claimed: (i) chronic fatigue syndrome, (ii) osteopenia of the left femoral neck, (iii) osteopenia of the lumbar spine, (iv) colon surgery, (v) appendectomy, (vi) left lapingo-oophroectomy, (vii) hysterectomy, and (viii) infertility is at least as likely as not proximately due to OR aggravated beyond its natural progression by service-connected endometriosis. An in-person VA examination should not be obtained for any of the claimed disorders, unless deemed necessary by the VA medical opinion provider. The full claims file should be reviewed, to include VA and private medical records, the October 2013 VA examination, the multiple private DBQs and medical opinions for the claimed disorders received in June 2014, and the September 2021 private medical opinion. A fully articulated medical rationale for EACH opinion expressed must be set forth in the medical report. The VA medical opinion provider should discuss the particulars of this Veteran's medical history and relevant medical science as applicable to this case, which may reasonably explain the medical guidance in the study of this case. H.M. WALKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Lindio 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.