Citation Nr: 21030299 Decision Date: 05/18/21 Archive Date: 05/18/21 DOCKET NO. 15-01 136 DATE: May 18, 2021 ORDER A rating in excess of 30 percent for residuals status-post hysterectomy for chronic cervicitis with squamous metaplasia with pelvic adhesions and left salpingo oophorectomy (residuals status-post hysterectomy and left salpingo oophorectomy) is denied. Service connection for a disability due to hormonal abnormalities, claimed as secondary to the residuals status-post hysterectomy and left salpingo oophorectomy, is denied. FINDINGS OF FACT 1. In February 2001, the Veteran's uterus was removed; the right ovary remains intact. 2. The evidence does not show that the Veteran has a current hormonal disability. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 30 percent for residuals status-post hysterectomy for chronic cervicitis with squamous metaplasia with pelvic adhesions and left salpingo oophorectomy (residuals status post hysterectomy and left salpingo oophorectomy) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.116, Diagnostic Code (DC) 7618. 2. The criteria for service connection for a hormonal disability, to include as secondary to residuals status post hysterectomy and left salpingo oophorectomy have not been met. 38 U.S.C.§§ 1110, 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 April 2000. The Board testified before the undersigned in November 2017. A copy of these proceedings is of record. These matters were most recently before the Board in August 2018. At that time, the Board remanded the appeal to have the Agency of Original Jurisdiction (AOJ) obtain outstanding VA treatment records and to schedule the Veteran for a VA psychiatric examination to determine the etiology of her diagnosed panic disorder and its relationship to the service-connected residuals status post hysterectomy for chronic cervicitis with squamous metaplasia with pelvic adhesions and left salpingo oophorectomy (residuals status post hysterectomy and left salpingo oophorectomy). VA treatment records were received into the record in May and July 2019, and VA examined the Veteran in June 2019. See June 2019 VA Mental and Endocrine Disability Benefit Questionnaires (DBQs). Thus, the requested development has been accomplished, and the appeal has returned for further appellate consideration. i) A rating in excess of 30 percent for residuals status-post hysterectomy for chronic cervicitis with squamous metaplasia with pelvic adhesions and left salpingo oophorectomy (residuals status post hysterectomy and left salpingo oophorectomy) is denied. The Veteran seeks a disability rating in excess of 30 percent for residuals status-post hysterectomy and left salpingo oophorectomy). The Veteran's gynecological disability is currently rated pursuant to DC 7618, which provides for a maximum 30 percent rating for removal of the uterus, following a temporary period of total disability. Upon review, the Board finds that the weight of the evidence of record is against a disability rating in excess of 30 percent at any point during the period on appeal. 38 C.F.R. § 4.116, DC 7618. In that regard, a 30 percent is the highest rating available for removal of the uterus, with the exception of the three-month period immediately following such removal. Furthermore, as a 30 percent rating is the maximum under Diagnostic Code 7615, the DC used to evaluate disease of the ovary, injury, or adhesions of, this code is also not for application. In addition, as the Veteran still has her right ovary, Diagnostic Code 8617, the DC used to rate removal of the uterus and ovaries, is inapplicable. As such, entitlement to a disability rating in excess of 30 percent must be denied. The Board does note that in addition to the 30 percent rating that has been assigned, the Veteran is also in receipt of special monthly compensation for the anatomical loss of a creative organ. 38 U.S.C. § 1114 (k); 38 C.F.R. § 3.350 (a). ii) Service connection for a disability due to hormonal abnormalities, secondary to the residuals status post hysterectomy and left salpingo oophorectomy, to include an acquired psychiatric disability and a skin disability is denied. The Veteran seeks service connection for a hormonal disability and symptoms related thereto as secondary to her service-connected residuals status-post hysterectomy and left salpingo oophorectomy. Specifically, she maintains that after she had her uterus and left ovary removed in 2000 and 2006, respectively, she was prescribed birth control for hormone abnormalities, which, in turn, caused a myriad of other problems, such as skin issues and panic attacks. Transcript (T.) at pages (pgs.) 3-4)). Service connection for a disability due to hormonal abnormalities, secondary to the residuals status-post hysterectomy and left salpingo oophorectomy, is denied. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. Generally, service connection requires three elements: (1) a current disability diagnosis; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). In addition, certain chronic diseases will be presumed related to service if they were noted or diagnosed as chronic in service; or if they manifested to a compensable degree within one year after active duty discharge; or if chronicity or continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012). Secondary service connection will be granted if the evidence demonstrates that a current disability is proximately due to or the result of, or is aggravated beyond its natural progression, by service-connected disability. 38 C.F.R. § 3.310. Following the Veteran's hearing testimony, the Board remanded the Veteran's claim in part to obtain medical opinions to determine whether the Veteran had a specific hormone disorder as a result of her hysterectomy, and whether either the procedure, or treatment following the procedure, led her to develop either skin problems or mental health problems, such as panic attacks. A VA examiner opined in June 2019 that there was insufficient evidence to warrant or confirm a diagnosis of acute or chronic hormonal disability claimed to be proximately due to or the result of service-connected status-post hysterectomy because the Veteran did not have a chronic hormonal disability. The examiner reasoned that his conclusion was based on extensive and comprehensive medical records, including objective gynecological and dermatological records and diagnostic testing with normal hormone laboratories, which did not support the conclusion that she had a hormonal disability. The June 2019 VA examiner's conclusion is supported by the other evidence of record, notably a January 2011 VA examiner's conclusion that there was no medical documentation or objective evidence to support a diagnosis of abnormal laboratory results claimed as hormonal abnormalities secondary to hysterectomy and more recent VA treatment records reflecting that the Veteran had not been prescribed any hormonal replacement therapy. There is no medical evidence suggesting a diagnosis of a hormonal disability or that any such disability may have been caused by the service-connected hysterectomy and left salpingo oophorectomy, or any residuals therefrom, to include during the pendency of the appeal or recent in time to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). However, a closer reading of the Veteran's testimony also suggests that her contention is not so much that she has a hormone disorder as there was a hormone imbalance of some kind which was treated with the prescription of birth control, and that this then led to the development of skin and psychiatric problems. Specifically, the Veteran has suggested that she has experienced symptoms, such as skin and urinary disabilities, psychiatric disability manifested by night sweats and hot flashes, left ovary removal and left breast fibroadenoma are the result of a hormonal disability. As noted above, VA examiners in January 2011 and June 2019 have not identified any signs or symptoms or diagnosis of a hormonal disability, and did not give a nexus opinion due to the absence of a diagnosis. Additionally, as the Veteran testified that she no longer experienced pain after her hysterectomy and left ovary removal, there is no evidence of pain that limits the functional impairment of earning capacity for a disability. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). The evidence does not support, nor is the Veteran competent to provide a diagnosis or opinion as to the cause or etiology of any hormonal disability. These are complex questions that require medical training and/or expertise due to the involvement and interaction of endocrine and gynecological systems in the body, as well as interpretation of the Veteran's medical history and any necessary tests. Turning to the question of whether the Veteran contention that after the hysterectomy (albeit perhaps years after the hysterectomy) she began to experience panic attacks and skin problems. She recalled seeking treatment at VA had being told that she had perhaps a hormone imbalance of some kind. For this reason, she experienced she was placed on birth control, and she recalls subsequently beginning to experience panic attacks and skin problems. This has made her wonder if there is a connection. To address the issue of panic attacks, the Veteran was scheduled for a VA psychiatric examination with a clinical psychologist. After interviewing the Veteran and reviewing her file, the examiner opined that Veteran's diagnosed panic disorder was less likely than not to be either proximately due to or the result of hysterectomy residuals. The examiner noted that the Veteran had undergone a hysterectomy in 2001, but had not reported any mental health symptoms (panic attacks) until 2008. The examiner noted that a review of 2008-2009 mental health treatment notes did not indicate any link between her anxiety and status post hysterectomy. Rather, her anxiety was described as being situational and exacerbated by family stressors and at one point by the misuse of alcohol. This is the most comprehensive medical opinion and it is afforded great weight. The Veteran was also provided an examination of her skin. The examiner observed the circular scattered brown spots that she was complaining about on her face, left forearm and both thighs, but found that they were consistent with January 2019 dermatology diagnoses of Solar degeneration (dermatoheliosis) and multiple benign melanocytic nevi. The examiner explained that the skin lesions were not caused by or related to any claimed hormonal disability, but rather were the result of long term sun exposure. (Continued on the next page) Accordingly, neither a panic disorder, nor a skin disorder has been found by the probative medical evidence to have been caused by the Veteran's hysterectomy or any treatment for or residuals thereof. Here the weight of the evidence is against the conclusion that the Veteran has any additional disability as a result of her hysterectomy, and, as such, service connection is denied. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Carole Kammel, 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.