Citation Nr: 21008992 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 16-22 696 DATE: February 18, 2021 REMANDED Entitlement to service connection for sciatic nerve damage of the right lower extremity is remanded. Entitlement to service connection for residuals of a heart valve replacement is remanded. Entitlement to service connection for a reproductive system disability is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1982 to June 1986. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a May 2010 rating decision by the Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran presented testimony at a Board hearing in January 2019. A transcript of the hearing is associated with the Veteran’s claims folder. This case was previously before the Board in June 2019, on which occasion the claims were remanded. 1. Entitlement to service connection for sciatic nerve damage of the right lower extremity is remanded. 2. Entitlement to service connection for residuals of a heart valve replacement is remanded. Upon review of the claims file, the Board has determined that further development is necessary before the claim can be adjudicated. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. In the Board’s June 2019 opinion, the Veteran’s claim of service connection for right lower extremity sciatic nerve damage and residuals of a heart valve replacement were remanded for further development. In remanding the aforementioned claims, the Board directed the RO to request the Veteran’s medical records from Bethesda Naval Hospital. In November 2019 the RO submitted a request for information for the Veteran’s hospital records for the period of January 1982 to December 1984. The RO subsequently received a negative response, indicating that the Veteran did not receive treatment at Bethesda Naval Hospital during this period of time. (11/6/2019, Request for Information, p. 1); (11/25/2019, Request for Information, 2). While the RO did comply with the Board’s June 2019 remand directives, they failed to request hospital records for the Veteran’s entire period of service. As previously noted, the RO requested records up to December 1984, but the Veteran served on active duty until June 1986. As there may be outstanding in-service hospital records, a remand is required to allow VA to request these potentially relevant records. Upon remand, the RO should request the Veteran’s Bethesda Naval Hospital records for the period of December 1984 to July 1986. 3. Entitlement to service connection for a reproductive system disability is remanded. Upon review of the claims file, the Board has determined that further development is necessary before the claim can be adjudicated. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. In June 2019, the Board remanded the Veteran’s claim for a reproductive system disability for further development. Specifically, the Board requested an opinion on whether the Veteran’s reproductive system disability is related to her in-service diagnosis of pelvic inflammatory disease. In January 2020 the Veteran was afforded a VA examination and opinion. The VA examiner opined that the Veteran’s reproductive system disability was less likely than not incurred in or caused by her service. In rendering an opinion, the examiner indicated that while the Veteran was diagnosed with pelvic inflammatory disease during her period of active duty service, the condition resolved prior to her discharge. (1/30/2020, C&P Exam, p. 2). In September 2020 a Camp Lejeune contaminated water (CLCW) subject matter expert proffered an opinion regarding whether the Veteran’s reproductive system disability was related to CLCW. The examiner opined that the Veteran’s reproductive system disability was less likely than not related to CLCW. In rendering an opinion, the examiner noted that the Veteran was diagnosed with pelvic inflammatory disease during service, which the examiner indicated contributed to the development of a fallopian tube obstruction and tissue scarring of her reproductive organ. (10/1/2020, C&P Exam, p. 7). While fallopian tube obstruction and tissue scarring of the reproductive organ can lead to infertility, the September 2020 examiner ultimately concluded that the Veteran’s infertility was the result of a post-service hysterectomy. The examiner indicated that her hysterectomy was needed due to “multiple uterine fibroids.” (10/1/2020, C&P Exam, p. 8). The examiner did not discuss the relationship between pelvic inflammatory disease and uterine fibroids. After a review of the January 2020 and September 2020 examinations, the Board finds that a fully informed decision on the issue of service connection for a reproductive system disability cannot be made because no VA examiner has opined on the relationship between uterine fibroids, ovary cysts, or dermoid cysts, and pelvic inflammatory disease. Upon remand, the RO should request a medical opinion addressing whether the Veteran’s in-service pelvic inflammatory disease at least as likely as not caused, or contributed to the development of, uterine fibroids, ovary cysts, or dermoid cysts. Additionally, as the September 2020 examiner opined that pelvic inflammatory disease caused fallopian tube obstruction and tissue scarring of the reproductive organ, the examiner should opine on whether the post-pelvic inflammatory disease residuals of fallopian tube obstruction and tissue scarring of the reproductive organ at least as likely as not caused, or contributed to the development of, uterine fibroids, ovary cysts, or dermoid cysts. The matters are REMANDED for the following action: 1. The AOJ should obtain copies of VA treatment records for the Veteran’s disabilities from September 2020 to the present. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s reproductive system disability is at least as likely as not related to an in-service diagnosis of pelvic inflammatory disease. In rendering an opinion, the examiner must address the following questions: (a.) Did the Veteran’s in-service pelvic inflammatory disease at least as likely as not cause, or contribute to the development of, uterine fibroids, ovary cysts, or dermoid cysts? (b.) Did post-pelvic inflammatory disease residuals of fallopian tube obstruction and tissue scarring of the reproductive organ at least as likely as not cause, or contribute to the development of, uterine fibroids, ovary cysts, or dermoid cysts? Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Glenn, 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.