Citation Nr: 21013348 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 16-33 196 DATE: March 9, 2021 ORDER Entitlement to service connection for a gynecological disability, diagnosed as polycystic ovarian syndrome (PCOS), is denied. REMANDED Entitlement to service connection for tachycardia, to include as due to hypertension, is remanded. Entitlement to service connection for hypertension, to include as due to tachycardia, is remanded. FINDING OF FACT PCOS did not have its clinical onset in service and is not otherwise related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for a gynecological disability, diagnosed as PCOS, are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from October 2002 to October 2006. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In January 2019, the Veteran testified before the undersigned Veterans Law Judge. In May 2019, the Board remanded the appeal for further development. Service Connection 1. Entitlement to service connection for a gynecological disability, diagnosed as PCOS, is denied. Service connection may be established for disability resulting from injury or disease incurred during active service. 38 U.S.C. § 1110. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, to establish service connection the evidence 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 in or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The Veteran maintains that her gynecological disability had its onset during service when she was diagnosed with cervical dysplasia and that she had no problems prior to service. See January 2019 Board Hearing Transcript at 17. Here, the Veteran has a current diagnosis of polycystic ovarian syndrome (PCOS). See November 2020 VA examination report. Thus, element one is met. As to element two, in-service incurrence of a disease or injury, the Veteran’s service treatment records (STRs) note cervix symptomatology and cervical dysplasia. See December 2004 and 2005/2006 STRs. Thus, element two is also established. Lastly, regarding the final element, nexus, the only competent opinion of record, that of the November 2020 VA examiner, is against the claim. Specifically, after a thorough review of the claims file, the examiner opined that the Veteran’s PCOS was less likely than not incurred in or caused by service. In support of her opinion the examiner noted the Veteran had a diagnosis of PCOS, which is associated with signs of weight gain, acne, irregular periods, infertility, and excessive hair growth. To this end, she stated there was no evidence to suggest that this condition began while in service. Additionally, with regard to cervical dysplasia noted during service, the examiner stated that this was a common abnormal finding with pap smear screens and were often followed up with colposcopy. She noted the records did not show the results of her prior colposcopy, though the Veteran reported it was normal, which supports that examiner’s assessment that in-service cervical dysplasia was not supportive of any disease of the cervix. The examiner further explained that pap smears were a routine screening tool for cervical cancer and have high false positive rates, meaning cervical dysplasia may be found on the pap smear but confirmatory colposcopy may be normal, as was the case with the Veteran. Thus, she found that the Veteran’s medical records did not support her claim, and ultimately concluded PCOS was less likely than not incurred in or caused by the cervical dysplasia during service. The Board finds this opinion highly probative, as it is well-reasoned and based on an accurate review of the Veteran’s medical history. To the extent the Veteran attributes her PCOS to service her opinion is not competent. Although the Veteran is competent to report on readily observable symptoms, she is not competent to determine the nature or etiology of PCOS. As a lay person, she has not been shown to be capable of making such conclusions on inherently medical questions. Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). The conclusion that the Veteran incurred a gynecological disability, including PCOS, during service is a determination requiring specialized knowledge and testing to understand the complex nature of the female reproductive system. As such, for reasons and bases outlined above, a preponderance of the evidence is against the claim. Accordingly, the benefit of the doubt doctrine does not apply, and service connection for a gynecological disability, diagnosed as PCOS, is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. REASONS FOR REMAND 2. Entitlement to service connection for tachycardia, to include as due to hypertension, is remanded. Pursuant to the Board’s May 2019 remand directives, the Veteran was afforded VA examinations in November 2020. The Board asked the examiner to opine on whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s tachycardia had its onset in service, is otherwise related to service, or manifested within a year after discharge from service. In doing so, the examiner was instructed to please address the Veteran’s testimony that she initially felt a rapid heart rate, jitteriness, and shortness of breath during service that has continued and worsened, as well as the June 2006 STR noting the Veteran’s heart rate was “not slow,” but also “not fast.” However, the examiner failed to address the Veteran’s testimony regarding her symptoms during service as specifically requested by the Board, particularly shortness of breath and jitteriness. Thus, for these reasons, an addendum opinion from a different examiner is needed on remand to ensure substantial compliance with the Board’s May 2019 remand directives. Stegall v. West, 11 Vet. App. 268 (1998). 3. Entitlement to service connection for hypertension, to include as due to tachycardia, is remanded. Any outstanding treatment records should also be secured on remand. In this regard, the Board notes that the Veteran does not have a current diagnosis of hypertension, thus action on her hypertension claim is deferred pending this development. In any event, the Veteran’s hypertension is intertwined with her tachycardia claim. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain any relevant outstanding private treatment records. 3. Then obtain an addendum opinion from a VA examiner other than the November 2020 examiner to determine the etiology of the Veteran’s tachycardia. The claims file, to include a copy of this remand, must be made available to the examiner for review, and the examination report must reflect that such a review was accomplished. No additional examination of the Veteran is necessary, unless the examiner determines otherwise. The examiner should opine on whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s diagnosed paroxysmal tachycardia (see November 2020 VA examination report) had its onset in service, is otherwise related to service, or manifested within a year after discharge from service? In addressing this question, the examiner must address the Veteran’s testimony that she initially felt a rapid heart rate, jitteriness, and shortness of breath during service that has continued and worsened, as well as the June 2006 STR noting the Veteran’s heart rate was “not slow,” but also “not fast.” The examiner should assume as true the Veteran’s reported symptomatology during service and provide a nexus opinion on whether a relationship between paroxysmal tachycardia and service is medically consistent with the same. A complete rationale must be provided for all opinions expressed. If for any reason the examiner is unable to provide a medical opinion, he or she should provide a rationale for that conclusion (e.g. whether there is any additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge). S. BUSH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Asante, Ruby 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.