Citation Nr: 21020787 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 18-25 263 DATE: April 8, 2021 ORDER Entitlement to service connection for residuals of bilateral breast surgery is granted. REMANDED Entitlement to service connection for a psychiatric disorder is remanded. FINDINGS OF FACT 1. The Veteran’s enlistment examinations contain no indications of disabilities or abnormalities of the breasts or back. 2. The Veteran’s service records show that her treatment providers convinced her to undergo breast surgery to treat back pain during her service. 3. The Veteran’s treatment records document persistent residuals of the breast surgery including pain, changes in sensation, and scarring. CONCLUSION OF LAW The criteria for service connection for residuals of a breast surgery are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from February 1993 to July 2001. This appeal comes to the Board from an October 2015 rating decision. The Veteran testified at an August 2020 hearing. Service connection is granted on a direct basis when there is competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. 38 U.S.C. § 1110; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The Board finds the elements for service connection are met. The Veteran’s service treatment records and VA examinations show she has residuals of a breast surgery during service including pain, changes in sensation, and scarring. See May 2015 VA Breast Conditions examination. The Veteran’s November 1992 enlistment examination contains no indications of disabilities or abnormalities of the breasts or back. The service treatment records from December 1996 show the Veteran began to experience back pain and breast discomfort during her military service. Her treatment providers recommended that she undergo surgery to reduce her breast size and improve her back pain. Her service treatment records document a March 1997 hospital admission to treat bilateral macromastia with a bilateral reduction mammoplasty. The Board finds that the Veteran’s current breast disabilities are residuals of her in-service surgery and are not related to any disability that preexisted her military service. Therefore, the Board grants her claim. REASONS FOR REMAND The Veteran receives treatment for mental disabilities at VA facilities and private facilities to include depression and anxiety. See April 2014 treatment records from Tornik Family Medicine. In January 2015, she filed a claim for service connection for post-partum depression following giving birth during her military service in 2001. She has since testified at her hearing and provided multiple written statements about military sexual trauma (MST) events. Her May 2001 separation examination notes mental health complaints that were not documented on her enlistment examination. The Veteran also indicated at the hearing that her breast surgery complications aggravated her mental disabilities. Based upon this, additional development is needed as described below. The matters are REMANDED for the following action: 1. VA should provide the Veteran with notice about the elements for establishing a claim based on military sexual trauma, including the types of evidence VA may consider. In the same letter, VA should ask the Veteran to identify outstanding records. It should attempt to obtain the records and associate them with the file. After VA provides the Veteran with the notice and adds outstanding records to the file, it should obtain a VA examination of her mental disabilities. VA should provide the examiner with the claims file and ask the examiner to address the following, with a detailed rationale with reference to the Veteran’s statements about worsening mental health associated with her service-connected disabilities. (a.) The VA examiner should identify all mental disabilities that the Veteran has experienced under both the DSM-IV and DSM-5 based on a review of the claims file and an examination of the Veteran if she is willing and able to attend. (b.) The VA examiner should opine whether it is at least as likely as not (50 percent or greater probability) each mental disability began during or was otherwise caused by the Veteran’s military service. The examiner should consider pertinent evidence including the Veteran’s statements about the history of her symptoms following military sexual traumas and the birth of her child during service. The examiner should note that while the Veteran’s enlistment examination contains no mental health complaints, the separation examination notes several complaints. (c.) The VA examiner should opine whether it is at least as likely as not the Veteran’s service-connected disabilities including residuals of breast surgery caused or aggravated each mental disability. The aggravation does not have to be permanent. Temporary aggravation may suffice for service connection. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Michael Duffy, 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.