Citation Nr: 21005726 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 13-34 488 DATE: February 2, 2021 ORDER Entitlement to service connection for pelvic inflammatory disease (PID) is denied. REMANDED Entitlement to service connection for abdominal pain is remanded. Entitlement to service connection for a skin disorder, to include hives, is remanded. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has had PID at any time during or approximate to the pendency of the claim. CONCLUSION OF LAW The criteria for service connection for PID are not 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 August 1988 to March 1991 in the United States Marine Corps. Service Connection Entitlement to service connection for PID is denied. The Veteran contends that she has PID that is etiologically related to active duty service. Alternatively, she contends that she has residuals of PID. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of PID and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Veteran’s September 2013 and March 2019 VA examinations addressed the Veteran’s PID claim, however the results of these examinations were deemed inadequate by subsequent Board decisions and will not be addressed in substance. In a March 2020 addendum opinion, a VA examiner determined that, while the Veteran experienced subjective symptoms of abdominal pain, she did not have a diagnosis of PID. The examiner specifically cited the resolution of this condition in 1990 and the lack of residuals or reoccurrence. Further, despite attempts to obtain the Veteran’s June 2013 pap smear, the necessary release was never returned. Despite this fact, the VA examiner remarked that even an abnormal pap smear would be “unrelated anatomically to [the] pelvis and ‘less likely than not’ from PID which has resolved 20/more years earlier.” While the Veteran believes she has a current diagnosis of PID, she is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. REASONS FOR REMAND 1. Entitlement service-connection for a skin disorder, to include hives is remanded. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for a skin disorder, to include hives, because no VA examiner has opined whether the Veteran has had hives or any other skin disoder at any point during the appeal period. The most recent addendum opinion focused solely on the lack of current objective evidence of any skin condition. To date, no examiner has addressed whether the evidence of record indicates that the Veteran had a skin disorder to include hives at any point during the period on appeal. 2. Entitlement to service connection for abdominal pain is remanded. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for abdominal pain because no VA examiner has adequately opined whether the Veteran’s abdominal pain alone represents a disability that is etiologically related to active duty service. Pain alone, even without an underlying pathology or diagnosis, can constitute a disability under VA law where such pain results in functional impairment. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). These matters are REMANDED for the following actions: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran has had a skin disorder, to include hives, at any point during the appeal period. If so, the examiner should address whether the disorder is “at least as likely as not” related to active duty service. The examiner must specifically address the medical and lay evidence of record, to include competent statements from the Veteran, family, co-workers, and fellow servicemembers regarding the existence of a skin condition, to include hives. The examiner must provide adequate supporting rationale for all medical conclusions reached. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s abdominal pain results in functional impairment of earning capacity. For any identified functional impairment, the examiner must opinion whether it is “at least as likely as not” related to an in-service injury event, or disease. The examiner must provide adequate supporting rationale for all medical conclusions reached. Michael L. Marcum Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P.S. McLeod 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.