Citation Nr: 21028214 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 15-27 304 DATE: May 10, 2021 ORDER Entitlement to service connection of a gynecological disorder, diagnosed as uterine fibroids, is denied. Entitlement to service connection of a left hip disorder, claimed as trochanteric bursitis and hip flexure tendinitis, to include as due to a service-connected right hip disability, is denied. Entitlement to service connection of left knee patellofemoral syndrome, to include as due to a service-connected right knee disability, is denied. FINDINGS OF FACT 1. The Veteran's gynecological disorder, diagnosed as uterine fibroids, was not shown in service or for many years thereafter and is not otherwise related to service. 2. The Veteran's left hip disorder, claimed as trochanteric bursitis and hip flexure tendinitis, was not shown in service or for many years thereafter and is not otherwise related to service, including as due to a service-connected right hip disability. 3. The Veteran's left knee patellofemoral syndrome was not shown in service or for many years thereafter and is not otherwise related to service, including as due to a service-connected right knee disability. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection of a gynecological disorder, diagnosed as uterine fibroids, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection of a left hip disorder, claimed as trochanteric bursitis and hip flexure tendinitis, to include as due to a service-connected right hip disability, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for entitlement to service connection of left knee patellofemoral syndrome, to include as due to a service-connected right knee disability, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1996 to July 1997. These matters return to the Board of Veterans' Appeal (Board) following the issuance of a September 2020 remand order which directed the Regional Office (RO) to complete additional development. Service Connection The law provides that service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. Service connection may 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, establishing service connection requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999). Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) a current disability; (2) a service-connected disability; and (3) a nexus between the current disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1988). As to the third Wallin element, the current disability may be either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). The law provides that a veteran is presumed to be in sound condition except for defects noted when examined and accepted for service; and when defects are noted upon entry the presumption of soundness does not apply and the presumption of aggravation is for application. See 38 U.S.C. §§ 1111, 1137; 38 C.F.R. § 3.304 (b). A preexisting injury or disease will be considered to have been aggravated by active service where there is an increase in disability during such service, unless clear and unmistakable evidence shows that the increase in disability is due to the natural progress of the disease. See 38 U.S.C. § 1153; 38 C.F.R. § 3.306. 1. Entitlement to service connection of a gynecological disability, diagnosed as uterine fibroids 2. Entitlement to service connection of a left hip disorder, claimed as trochanteric bursitis and hip flexure tendinitis, to include as due to a service-connected right hip disability, is denied. 3. Entitlement to service connection of left knee patellofemoral syndrome, to include as due to a service-connected right knee disability, is denied The Veteran is seeking service connection for a gynecological disorder, diagnosed as uterine fibroids, as well as for a left hip disorder and a left knee disorder. As an initial matter, the Board notes that the Veteran has diagnoses for each of the disorders on appeal. After a review of the evidence, the Board finds that service connection is not warranted for any of the claimed disorders on appeal. The Veteran's service treatment records are silent for any indications of uterine fibroids, including at the Veteran's entrance examination. The Veteran's records do note knee and hip pain, however, there is no indication of a chronic or diagnosed disorder for either. The first indication of any of the disorders on appeal was in June 2011, and approximately 14 years since active duty service, when the Veteran first submitted a claim for service connection. There are no medical records in the period between active duty and the submission of these claims. Additionally, the Veteran did not have formal diagnoses for her left hip and knee disorders until September 2012, a diagnosis of uterine fibroids was made in 2019. Therefore, continuity of symptoms has not been shown based on the clinical evidence of record. The Board recognizes the statements from the Veteran regarding his history of her disorders since service. While the Veteran is competent to report that she experienced symptoms of this disorders since service, she is not competent to provide diagnoses in this case or determine that these symptoms were manifestations of her current disorder. See Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). In any event, the Board determines that the Veteran's reported history of continued symptomatology since active service, while competent, is nonetheless insufficient in establishing a relationship between her disorders and service. The large gap in treatment for the asserted conditions weighs against the Veteran's claims. See Kahana v. Shinseki, 24 Vet. App. 428, at 439-40 (2014) (The Board may weigh silence in a medical record against lay testimony if the alleged injury, disease, or related symptoms would ordinarily have been recorded in the medical record being evaluated). Next, although continuous symptoms have not been shown, service connection may nonetheless be established if the evidence otherwise indicates a nexus between active duty service and her current symptoms. In this case, however, the competent evidence fails to establish a relationship between active duty and the Veteran's current symptoms. Specifically, the Veteran has not provided sufficient evidence, including private opinions and/or medical evidence, to establish a relationship between her disorders and active service. Next, although continuous symptoms have not been shown, service connection may nonetheless be established if the evidence otherwise indicates a nexus between active duty service and her current symptoms. In this case, the Board finds that the weight of the competent evidence does not attribute the Veteran's uterine fibroids, left knee disorder, or left hip disorder to active duty, despite her contentions to the contrary. To this end, the Veteran was provided with VA examinations in September 2012, December 2019, and December 2020. In a January 2019 Board decision, the Board determined that the examinations conducted in September 2012 were inadequate for the purposes of adjudicating the Veteran's claims. The September 2020 Board decision noted deficiencies with the December 2019 examinations of the Veteran's left hip and knee in that the Veteran's lay statements were not considered, nor were the noted instances of pain in her left hip and knee during service. The Board will thus not consider the examinations noted to be inadequate for the purposes of adjudication in the present decision. At the December 2019 examination for her gynecological symptoms, the Veteran failed to appear for a pelvic ultrasound so a concrete diagnosis could not be endorsed by the examiner. The Veteran did report general right lower quadrant pain and twinging. However, the examiner noted that such a vague description could not allow them to estimate a diagnosis much less link the Veteran's symptoms to active duty service. Additionally, they indicated that they could not opine as to the Veteran's current symptomatology being the same as what she experienced in service. Next, at the Veteran's December 2020 gynecological examination, the examiner endorsed a diagnosis of uterine fibroids which had been confirmed by an ultrasound in the previous year. The examiner opined that the Veteran's uterine fibroids were less likely than not related to service including her noted episodes of abdominal pain. Additionally, the examiner noted that there was no evidence to support the notion that her current disorder was related to her pre-service ovarian cysts or her in-service pregnancy, and that her current disorder did not, itself, predate service. At the Veteran's December 2020 left hip examination, the Veteran endorsed left hip pain and tenderness. The examiner noted that her in-service medical records were absent for an event of acute or chronic left hip pain, including a specific injury. They also noted that the Veteran's medical records were absent for left hip pain treatment since service and prior to her initial claim. In discussing, the potential relationship between her right hip disability and left hip disorder, the examiner opined that her left hip disorder was less likely than not related to her right hip disability and it should be considered to be independent of her right hip disability. The examiner noted that her disorder, diagnosed as trochanteric pain and left hip bursitis is a result of the natural aging process and/or chronic overuse. Finally, at her December 2020 left knee examination, the Veteran reported pain with flare-ups. The examiner opined that her left knee disorder was less likely than not related to her period of active duty service, including as secondary to her right knee disability. The examiner noted the lack of treatment in service for a chronic or acute left knee disorder and the lack of treatment since service in the Veteran's medical records between her active duty and her initial claim. The examiner opined that the Veteran's left knee disorder was less likely than not caused or aggravated by her right knee disability. The examiner indicated that the development of the Veteran's left knee disorder could be attributed to the natural aging process and/or overuse and was independent of her right knee disability. In arriving at this conclusion, the Board acknowledges the Veteran's statements that her current disorders are related to her time in service, including as due to other service-connected disabilities. The Federal Circuit has held that "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (quoting Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In this case, the Board recognizes that the Veteran is certainly competent to discuss observable symptoms such as pain. However, the Veteran is not competent to testify regarding nature or the etiology of her uterine fibroids, left knee disorder or left hip disorder. See Jandreau, 492 F.3d 1372 at 1377, n.4. Moreover, to the extent that she has discussed her symptoms, the Board has found such statements to not be credible to speak to the relation between them and her active duty service for the reasons stated above. Accordingly, the Board finds that service connection is not warranted for the Veteran's uterine fibroids, left knee disorder, and left hip disorder. Her claims are denied. 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. B.T. KNOPE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Q. Hernan, Attorney Advisor