Citation Nr: 21013333 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 12-30 185 DATE: March 9, 2021 ORDER Entitlement to an initial disability rating in excess of 10 percent for service-connected chronic recurrent vaginitis is denied. FINDING OF FACT For the entire period on appeal, the Veteran’s service-connected chronic recurrent vaginitis required and was controlled with continuous treatment. CONCLUSION OF LAW The criteria for entitlement to an initial disability rating in excess of 10 percent for service-connected chronic recurrent vaginitis have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.116, Diagnostic Code (DC) 7611. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1995 to June 1999. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in December 2009 by the Department of Veterans Affairs (VA) Regional Office (RO). In May 2016, the Board remanded the above listed issue to the RO to schedule the Veteran for a Board hearing. In a June 2016 Statement in Support of Claim, the Veteran withdrew her request for a Board hearing. In September 2019, the Board remanded the issue in order to obtain treatment records and an updated VA examination. Entitlement to an initial disability rating in excess of 10 percent for service-connected chronic recurrent vaginitis The Veteran seeks a higher initial rating for her service-connected vaginitis, which is currently rated 10 percent disabling effective May 27, 2008. In an August 2020 statement, the Veteran expressed that she has suffered from chronic recurrent vaginitis ever since her initial treatment for bacterial vaginitis in December of 1995.The Veteran stated that since her VA examination in January 2020, she has suffered from several recurrences of vaginitis, candida vaginitis, and bacterial vaginosis. Based on the frequency of recurrence and continuous treatment with prescription medications the Veteran contends that her symptoms are not controlled by continuous treatment. The Veteran’s vaginitis has been assigned an initial rating of 10 percent pursuant to 38 C.F.R. § 4.116, Diagnostic Code 7611. A General Rating Formula for Disease, Injury, or Adhesions of Female Reproductive Organs contains the actual rating criteria for evaluating the Veteran’s disability. Pursuant to this General Rating Formula, a 10 percent rating is warranted when the condition is manifested by symptoms that require continuous treatment and a maximum 30 percent rating is warranted if the condition is manifested by symptoms that are not controlled by continuous treatment. 38 C.F.R. § 4.116. In a June 2008 statement from Dr. T. Gellasch, the Veteran was noted to suffer from chronic vaginitis/vulvovaginitis and has been under the physician’s care since March 2006. In an August 2008 treatment note, the Veteran was noted to have bacterial vaginosis. In a June 2009 treatment note, the Veteran complained of chronic vaginitis since 1995. It was noted that the Veteran alters between taking Diflucan and Flagyl. The Veteran stated that she gets increase vaginal discharge when she wipes. She denied pain, burning sensation, dysuria, and dyspareunia. The Veteran was diagnosed with vaginitis. The physician indicated that the Veteran should stop all medications, if the Veteran has vaginal pain, itchiness, and dysuria. Diflucan and Flagyl were prescribed. The Veteran was afforded a VA examination in October 2009. The examiner noted that the medications prescribed were Diflucan and Flagyl tablets. The examiner reported that in May 2009, the Veteran was seen at Eastlake Family Medicine Clinic and was prescribed both Flagyl and Diflucan without benefit. The examiner reported that in June 2009, the Veteran had a followup with the same clinic, and the treating physician told the Veteran to stop both medications. The Veteran submitted a list of medication she was prescribed, received on March 2010. It noted that the Veteran was prescribed Metronidazole (Flagyl) in May 2009 and February 2010 and Fluconazole (Diflucan) in May 2009 and March 2010 for her bacterial vaginosis and yeast infection. The list also noted medication was prescribed for a urinary tract infection. The Veteran was afforded a VA examination in October 2011. After interviewing the Veteran and conducting an examination, the examiner found that the Veteran had a diagnosis of recurrent vaginitis. The examiner noted that the Veteran has had recurrent vaginitis since military service and has been treated intermittently with oral Diflucan, with no accompanying pain, dyspareunia or functional limitations. The examiner stated that the Veteran did not currently require treatment or medications for symptoms related to reproductive tract conditions, and that she had also been diagnosed with vulvovaginitis, recurrent, intermittent with a single episode of vulvar involvement. In an October 2012 substantive appeal to the Board, the Veteran stated that the October 2011 VA examination was inadequate because no vaginal examination was conducted, and the examiner concluded there was no current infection. The Veteran expressed that based on the abundance of medical evidence of record, clearly revealing both intermittent and nearly constant treatment of symptoms not controlled by continuous treatment, she is entitled a higher rating. The Veteran also expressed that the status of her service-connected chronic recurrent vaginitis is not always adequately assed by medical providers while being prescribed Metronidazole (Flagyl) or Fluconazole (Diflucan) medication, as it only causes her to “develop additional persisting infections of interrelations between bacterial vaginitis and yeast (candida).” See VA Form 9. The Veteran stated that her recurrent bacterial vaginosis would only clear up, leading to a yeast infection, and within a couple of days, it would reappear. An October 2019 test result showed that the Veteran had two common vaginal infections, yeast and bacterial vaginosis. It was noted that the recommendation was to treat bacterial infection first and then yeast one week later. The Veteran was afforded a VA examination in January 2020. The examiner diagnosed the Veteran with chronic recurrent vaginitis, candida vaginitis, bacterial vaginosis, and vulvovaginitis. The examiner also noted uterine fibroids, however the examiner stated that the uterine fibroids were unrelated to the service-connected recurrent vaginitis. The Veteran reported recurrent vaginitis in 2012, 2013, 2016, 2017, 2018, and 2019 with whitish discharge and foul odor, pain with intercourse, itching, and urinary frequency/incontinence. The examiner noted that the Veteran has symptoms related to her gynecological condition to include moderate and intermittent pain, and whitish discharge with foul odor, pain with intercourse, and vaginal itching. The examiner indicated that the Veteran does not currently require treatment for symptoms related to reproductive tract conditions. After careful review, the Board finds that for the entire period on appeal, while the Veteran has been continuously treated for recurring vaginitis with nearly constant treatment with medication such as Metronidazole (Flagyl) and Fluconazole (Diflucan), the preponderance of the competent medical evidence of record demonstrates that her service-connected gynecological disability has manifested symptoms that require continuous treatment, but which have been controlled by such continuous treatment, and therefore the Veteran’s service-connected chronic recurrent vaginitis does not warrant an increased evaluation in excess of 10 percent under Diagnostic Code 7611. The Board has also considered the Veteran’s statement noting that despite continuous medical treatment, the Veteran’s vaginitis has continued to return throughout the appeal; however, within the context of the other competent medical and lay evidence of record, the Board interprets the Veteran’s statement to refer to the frequent recurrence of vaginitis rather than to its manifestation of continuous symptoms unaffected by the prescribed medication. Thus, the evidence reflects that while the Veteran experiences recurrent vaginitis, her symptoms were controlled with continuous treatment. Accordingly, as all requested testing has been completed, and the record contains no evidence warranting a higher evaluation under Diagnostic Code 7611, the Board finds that a preponderance of the competent evidence of record fails to demonstrate that the Veteran’s service-connected recurrent vaginitis manifests symptoms not controlled by continuous treatment. Therefore, the Board concludes that the Veteran has been appropriately compensated for her service-connected gynecological disability, and that the preponderance of the evidence of record weighs against the assignment of an increased evaluation in excess of 10 percent under Diagnostic Code 7611. See 38 C.F.R. § 4.116. (Continued on the next page)   (CONTINUED ON NEXT PAGE) T.D. JONES Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.D. 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.