Citation Nr: 21012572 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 14-24 109A DATE: March 4, 2021 REMANDED Entitlement to service connection for vaginal vault prolapse is remanded. Entitlement to service connection for bladder prolapse with cystocele and urinary stress incontinence is remanded. Entitlement to a rating in excess of 10 percent for right foot hallux valgus is remanded. Entitlement to a rating in excess of 10 percent for left foot hallux valgus is remanded. Entitlement to a compensable rating for right great toe surgical scar associated with hallux valgus is remanded. REASONS FOR REMAND The Veteran served in the Army from July 1979 to July 1982. In September 2020, the Veteran withdrew her July 2014 request for a hearing before a Veterans Law Judge. 1. Entitlement to service connection for vaginal vault prolapse is remanded. 2. Entitlement to service connection for bladder prolapse with cystocele and urinary stress incontinence is remanded. The Veteran contends that her current diagnoses of vaginal vault prolapse and bladder prolapse with cystocele and urinary stress incontinence are secondary to her service-connected hysterectomy with bilateral salpingo oophorectomy due to history of menorrhagia, dysmenorrheal, and endometriosis. Service connection may be established on a secondary basis for a disability that is proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability was either caused by or aggravated by a service-connected disability. 38 C.F.R. § 3.310 (a) (2019); Allen v. Brown, 7 Vet. App. 439 (1995). In January 2017, a VA examiner opined that the Veteran’s vaginal vault prolapse and stress incontinence were less likely than not incurred in or caused by service, and less likely than not proximately due to or the result of hysterectomy with bilateral oophorectomy due to history of menorrhagia, dysmenorrheal, and endometriosis. However, the examiner did not comment as to whether the Veteran’s claimed disabilities were aggravated by her service-connected conditions. Causation and aggravation are independent concepts and should have separate findings and rationales. Atencio v. O’Rourke, 30 Vet. App. 74 (2018). An opinion to the effect that one disability “is not caused by or a result of” another disability does not answer the question of aggravation. El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013). The Board finds that a new VA medical opinion is necessary to determine whether the Veteran’s vaginal vault prolapse and bladder prolapse with cystocele and urinary stress incontinence are caused or aggravated by service-connected hysterectomy with bilateral salpingo oophorectomy due to history of menorrhagia, dysmenorrheal, and endometriosis. On remand, the VA examiner should consider a medical article submitted by the Veteran in February 2017. The medical article suggests that pelvic organ prolapse may be a long-term effect of hysterectomy. 3. Entitlement to a rating in excess of 10 percent for right foot hallux valgus is remanded. 4. Entitlement to a rating in excess of 10 percent for left foot hallux valgus is remanded. 5. Entitlement to a compensable rating for right great toe surgical scar associated with hallux valgus is remanded. The Veteran contends the severity of her right and left foot hallux valgus, and right great toe surgical scar associated with hallux valgus, warrant ratings in excess of those assigned. The Veteran was last provided VA examinations for her scar in November 2015, and the most recent medical evidence regarding the severity of her hallux valgus is from a private disability benefits questionnaire submitted by the Veteran in February 2016. The Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of her right and left foot hallux valgus, and right great toe surgical scar associated with hallux valgus. The matters are REMANDED for the following action: 1. Schedule the Veteran for VA examination(s) for vaginal vault prolapse and bladder prolapse with cystocele and urinary stress incontinence. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: Is the disability at least as likely as not related to service? Is the disability at least as likely as not proximately due to service-connected hysterectomy with bilateral salpingo oophorectomy due to history of menorrhagia, dysmenorrheal, and endometriosis? Is the disability at least as likely as not aggravated, i.e., worsened beyond its natural progression, by service-connected hysterectomy with bilateral salpingo oophorectomy due to history of menorrhagia, dysmenorrheal, and endometriosis? Provide a rationale to support the opinions. Separate rationales should be provided for both causation and aggravation. In providing an opinion and rationale, the examiner is asked to address a medical article submitted by the Veteran in February 2017 called “Long Term Effects of Hysterectomy” which suggests that pelvic organ prolapse may be a long-term effect of hysterectomy. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her service-connected left foot and right foot hallux valgus. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her service-connected right great toe surgical scar associated with hallux valgus. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Casey, 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.