Citation Nr: 21011208 Decision Date: 03/01/21 Archive Date: 03/01/21 DOCKET NO. 15-39 953 DATE: March 1, 2021 ORDER Entitlement to service connection for residuals of tubal ligation is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran had residuals from her tubal ligation that began during active service or are otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for residuals of tubal ligation 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 in the U.S. Army from August 1981 to May 1994. In November 2020, the Board remanded the above issue to obtain another VA opinion, which was subsequently obtained in November 2020. The Board is satisfied there was substantial compliance with its remand orders. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999); Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. To establish entitlement to service-connected compensation benefits, a veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may be granted for any disease initially diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). 1. Entitlement to service connection for residuals of tubal ligation is denied. The Veteran contends that she suffers from residuals due to a tubal ligation procedure she underwent while in service. In her September 2018 hearing, the Veteran testified that following the tubal ligation procedure, and beginning in service, she has had heavy bleeding and pain associated with her menstrual periods. First, with respect to a diagnosis, the July 2020 VA examiner noted that the Veteran has reported pain and heavy bleeding as a residual of her tubal ligation. As these symptoms are ones that are observable the Board finds that she can establish the presence of these residuals. Therefore, the first element of service connection, a disability, has been met. Second, with respect to an in-service incurrence, the Veteran’s STRs indicate that the Veteran had a tubal ligation performed in July 1989. Therefore, the second element of service connection, an in-service incurrence, has been met. Therefore, the only remaining issue is a nexus. With respect to a nexus, the November 2020 VA examiner opined that the Veteran’s residuals of tubal ligation are less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that the Veteran was evaluated in July 2020 for residuals of tubal ligation. The examiner also noted that the Veteran submitted a lay statement complaining of heavy menstrual periods and pain after the tubal ligation. She reported that a treating physician at Fort Benning stated that most women who have their tubes tied have symptoms of pain and excessively long and strong menstrual cycles. However, the examiner reasoned that the research has shown that women who have undergone sterilization were no more likely than those who had not undergone the procedure to report persistent changes in intermenstrual bleeding or the length of the menstrual cycle. They were more likely to have decreases in the number of days of bleeding. Among women who had had very heavy bleeding at baseline, women who had undergone tubal sterilization were more likely than women who had not undergone the procedure to report decreased bleeding. Therefore, the examiner concluded that the residuals of tubal ligation are less likely than not incurred in or caused by the in-service illness, event or injury. The November 2020 opinion is probative, it is based on an accurate medical history, considers the Veteran’s lay statements, and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). While the Veteran is competent to report having experienced symptoms of heavy bleeding and pain associated with her menstrual periods since service, she is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of residuals from her tubal ligation. The issue is medically complex. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Therefore, only probative evidence regarding a nexus is the November 2020 VA negative opinion. Lacking a nexus, the preponderance of the evidence weights against the claim. Based on the above, entitlement to service connection for residuals of tubal ligation is denied. GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. E. Grossman, 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.