Citation Nr: 21012022 Decision Date: 03/03/21 Archive Date: 03/03/21 DOCKET NO. 10-05 958 DATE: March 3, 2021 REMANDED Entitlement to a compensable rating for anterior and posterior intramural uterine fibroid tumors prior to April 13, 2015, and in excess of 30 percent, thereafter, is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) prior to May 21, 2015 is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1988 to July 1988, from August 1990 to June 1991, from January 2003 to January 2005, and from March 2007 to October 2008, as well as periods of active duty for training (ACDUTRA) and inactive duty training (INACDUTRA). The case was most recently before the Board in August 2019 when it was remanded for additional development. There has not been substantial compliance with the remand directives and the claims must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to a compensable rating for anterior and posterior intramural uterine fibroid tumors prior to April 13, 2015, and in excess of 30 percent, thereafter, is remanded. The claim must be remanded again because the August 2020 VA examination obtained after the last remand is inadequate. The record shows that the Veteran has experienced heavy menstrual bleeding that is associated with her uterine fibroids since at least 2008. The August 2020 VA examiner opined that the uterine fibroids is the most common cause for abnormal bleeding for women over 50. However, the Veteran was at least a decade younger while experiencing her symptoms. Additionally, the August 2020 examiner noted that the Veteran was treated with Provera (medroxyprogesterone) 10 milligrams (mg) once per day, for her uterine condition. The examiner then opined that Provera is not typically used to treat uterine fibroids but instead is used to treat secondary amenorrhea; abnormal bleeding from the uterus due to hormonal imbalance and not due to fibroids, or cancer. The opinion is inadequate because after the examiner acknowledges that the Veteran was prescribed Provera to treat her uterine condition but then says that Provera is not typically used to treat uterine fibroids. The examiner does not discuss the possibility that this Veteran’s treatment was not typical and thus, whether this Veteran’s treatment for uterine fibroids included medication use of Provera or other progesterone. On remand a new VA medical opinion is warranted. 1. Entitlement to TDIU prior to May 21, 2015 is remanded. The TDIU claim is inextricably intertwined with the service connection claim and adjudication of that issue will be deferred until the increased rating issue is decided. The matters are REMANDED for the following action: 1. Forward the claims file and copies of all pertinent records to an appropriate VA examiner (different than the August 2020 examiner, if possible) to obtain a medical opinion for the Veteran’s uterine fibroid disability claim. If the examiner determines that an opinion cannot be provided without an examination, one should be scheduled. The appropriate DBQ should be used. The examiner is asked to review and discuss, (i) a February 2010 medical treatment record documenting that the Veteran was prescribed progesterone (file receipt date September 2010) after the presence of uterine fibroids were documented via ultrasound in May 2009; and, (ii) whether the Veteran’s heavy bleeding documented as early as 2010 was a manifestation of her uterine fibroids that progesterone may have been prescribed to treat. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issue of entitlement TDIU. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. G. Perkins, 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.