Citation Nr: 21027570 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 17-62 596 DATE: May 6, 2021 REMANDED Entitlement to service connection for menorrhagia with uterine fibroids, claimed as a gynecological condition, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1987 to October 1991, with additional periods of service in the Marine Corps Reserves from October 1991 to January 2004 and the Air Force Reserves from January 2004 to January 2010. This case is before the Board of Veterans' Appeals (Board) on appeal from an April 2017 rating decision, which denied service connection for menorrhagia. The Veteran's notice of disagreement (NOD) was received in April 2017. The RO issued a statement of the case (SOC) in November 2017, and the Veteran's VA Form 9, substantive appeal to the Board, was received in November 2017. In September 2020, the Veteran testified at a virtual hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. 1. Entitlement to service connection for menorrhagia with uterine fibroids, claimed as a gynecological condition The Veteran contends that her claimed menorrhagia with uterine fibroids is related to active service. During the September 2020 Board hearing, the Veteran testified that it is her contention that her uterine fibroids did not have anything to do with her menorrhagia with anemia and that she had excessive bleeding and previous civilian doctors did not take her complaints of excessive bleeding seriously until around 2009 when a doctor noticed that her blood work showed anemia. She indicated that while she did have uterine fibroids, she admits that they were small and were not the cause of the excessive bleeding. In a November 2018 notice of disagreement (NOD) and during the September 2020 Board hearing, the Veteran asserted that service treatment records (STRs) for her active duty service from October 1987 to October 1991 are incomplete and illegible. The Veteran testified that she has also tried to retrieve copies of inpatient records from treatment at Camp Lejeune Naval Hospital but has not been successful. STRs for the Veteran's active and reserve duty service are of record; however, review of these records substantiates the Veteran's assertion that they are illegible. A review of the claims file reveals that an attempt to obtain the Veteran's STRs was made on December 15, 2009; however, additional attempts to obtain complete and legible copies of the Veteran's STRs from her period of active duty service have not been undertaken. Given the Veteran's contentions that her STRs are incomplete and illegible, remand is required to allow for further attempts to obtain these records and associate them with the claims file. In March 2017, the Veteran underwent a VA examination for her gynecological condition. The examination report indicates diagnoses of menorrhagia and uterine fibroids from 2012. The examiner provided an opinion that her menorrhagia is less likely as not related to a specific exposure event experienced by the Veteran during service in Southwest Asia. The examiner's rationale was that there is no evidence based on medical literature that proffers a nexus between uterine fibroids and exposure to environmental hazards. The examiner noted that the during the Veteran's active service from October 1987 to October 1991, she complained of heavy periods before she was placed on birth control and was treated with pills for anemia. However, a VA opinion addressing whether the Veteran's claimed gynecological condition, menorrhagia, is directly related to active service, is not of record. If VA undertakes the effort to provide the Veteran with a medical examination, it must ensure that such examination is an adequate one. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). As such, a VA opinion addressing the etiology of the Veteran's claimed gynecological condition on the theory of direct service connection must be obtained on remand. The matters are REMANDED for the following action: 1. Request from the service department and any other potential sources, the Veteran's complete and legible service treatment records from the Veteran's period of active duty service, including inpatient treatment records from Camp Lejeune Naval Hospital, and associate them with the claims file. All attempts to obtain any outstanding service treatment records must be documented in the claims file. If additional records are unavailable and the AOJ determines that further attempts to obtain higher quality records would be futile, such should be noted in the claims file with a formal finding of unavailability, and the Veteran and her representative should be so notified. 2. Obtain an addendum opinion (with examination if deemed necessary by the provider) from the VA examiner who performed the March 2017 VA examination for gynecological conditions, or from another appropriate provider if that examiner is unavailable. The examiner must review the claims file in conjunction with the examination, including the September 2020 Board hearing transcript. (a.) The examiner must provide a medical opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's gynecological condition, menorrhagia, was caused by disease or injury in service. The examiner must support any opinion rendered with a detailed rationale and address the Veteran's contentions, including that her menorrhagia was not caused by uterine fibroids but rather began during active service. If the examiner cannot provide the above opinion, the examiner is advised that he or she must explain why the requested opinion cannot be provided. The term "at least as likely as not" does not mean within the realm of possibility, but rather that the evidence both for and against a conclusion is so evenly divided that it is as sound to find in favor of a certain conclusion as it is to find against it. L. B. CRYAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Labi, 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.