Citation Nr: 21076139 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 16-00 800 DATE: December 22, 2021 REMANDED Entitlement to service connection for a gynecological disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from January 1993 to May 1993 and the United States Air Force from April 2002 to December 2002, February 2006 to September 2008, October 2008 to November 2008, April 2010 to May 2010, and October 2011 to December 2011, with additional reserve service. The Board remanded this claim most recently in March 2021. The March 2021 Board remand also included the issue of entitlement to service connection for bilateral pes planus. Subsequent to the Board's remand, the Agency of Original Jurisdiction (AOJ) granted service connection for bilateral pes planus in a May 2021 rating decision. This is a full grant of the benefits on appeal for the pes planus claim and it is no longer before the Board. See generally Grantham v. Brown, 114 F.3d 115 (Fed. Cir. 1997); Barrera v. Gober, 122 F.3d 1030 (Fed. Cir. 1997). 1. Entitlement to service connection for a gynecological disorder is remanded. The AOJ has obtained several medical opinions regarding the etiology of the Veteran's claimed gynecological disorder. As discussed in prior remands, the June 2019 and January 2020 opinions are inadequate. Unfortunately, the April, September, and October 2021 opinion obtained pursuant to the Board's most recent remand are also inadequate. Specifically, in the April 2021 opinion, the examiner notes that the Veteran's complaints of menstrual irregularities preexisted her second period of service, citing a 1997 complaint of irregular menstruation, but failed to provide an opinion on whether they were aggravated by her second or later periods of service or caused by her initial period of active duty. Confusingly, in the September and October 2021 opinions, the same examiner indicated that the Veteran's symptoms did not preexist service and that there was no documentation of such until March 2012. The examiner also failed to address the March 1993 service treatment record (STR) noting that the Veteran had complained of secondary amenorrhea for two months. Finally, the examiner concluded in October 2021 that there was no diagnostic evidence to suggest uterine pathology, but failed to address the December 2013 VA treatment record indicating that an ultrasound showed possible adenomyosis. Unfortunately, in light of these numerous deficiencies, the Veteran's claim must once again be remanded for a more thorough medical opinion. The matter is REMANDED for the following actions: 1. Obtain an addendum opinion from a VA examiner who has reviewed the claims file in its entirety to determine whether the Veteran's currently diagnosed dysmenorrhea and menorrhagia were caused or aggravated by service. The examiner should specifically address the following questions: (a.) Did the Veteran' dysmenorrhea and menorrhagia or any other gynecological disorder clearly and unmistakably (undebatable) preexist any period of active service? (b.) If the examiner finds that the disorders did clearly and unmistakably preexist any period of active service, the examiner must opine whether they were clearly and unmistakably NOT aggravated by service. (c) If the examiner finds that the disorders either did not clearly and unmistakably preexist service, or were not clearly and unmistakably aggravated by service, the examiner must opine whether they were at least as likely as not (at least an approximate balance of positive of negative evidence) related to an in-service injury, event, or disease. The examiner must specifically consider the following: 1. The March 1993 STR showing complaints of secondary amenorrhea times two months. 2. The Veteran's lay statements of onset of menstrual irregularities during her first period of active service. 3. The December 2013 VA treatment record noting that an ultrasound showed possible adenomyosis. A complete rationale must be provided for any opinion given. Be advised that an absence of medical literature is not a sufficient rationale for a negative opinion. The particular circumstances of the Veteran's case must be discussed in detail. 2. The Agency of Original Jurisdiction must review the examination report to ensure that it is complaint with the Board's instructions. If not, it must be returned to the examiner for completion and correction. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Moore, 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.