Citation Nr: 21031277 Decision Date: 05/21/21 Archive Date: 05/21/21 DOCKET NO. 18-29 045 DATE: May 21, 2021 ORDER Entitlement to service connection of uterine fibroids is granted. FINDING OF FACT The Veteran's uterine fibroids, status-post hysterectomy, had onset during active service. CONCLUSION OF LAW The criteria for service connection for uterine fibroids, status-post hysterectomy, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1995 to March 1998. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). As a matter of procedural background, this appeal previously came before the Board in May 2020, at which time it granted claims of service connection for a thoracolumbar spine and psychiatric disability, and remanded the uterine fibroid claim addressed herein for further development. Also remanded at that time were claims of service connection for bilateral knee, ankle and foot disabilities and also a kidney disability. In September 2020, the RO issued a rating decision which granted those claims in full and they are no longer part of this appeal. As was noted in the prior Board decision, the Veteran testified before the undersigned Veterans Law Judge at a hearing held at the Central Office in Washington DC in January 2020. A transcript of that hearing is of record. Service Connection The law provides that service connection may be granted for 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). 1. Entitlement to service connection of uterine fibroids The Veteran seeks service connection of uterine fibroids. The Board finds that the claim should be granted. The Veteran has a present diagnosis of uterine fibroids, status-post hysterectomy. It is noted that she underwent a hysterectomy in June 2015, during the pendency of this appeal, to resolve her condition which included complete removal of both ovaries. Although the situation has since been surgically "resolved," she did suffer from uterine fibroids for a portion of the appeal period. The Veteran asserts that her condition first manifested during active service. As was previously noted by the Board in the May 2020 remand, her service treatment records did not explicitly diagnose fibroids, but did include multiple requests for treatment for various gynecological issues. As such, the Board remanded the claim for an examination and medical opinion regarding the onset and etiology of her condition. Initially, the Board notes that uterine fibroids are not noted at entrance to service. The Veteran will be considered to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto. Only such conditions as are recorded in examinations reports are to be considered as noted. 38 C.F.R. § 3.304(b). Therefore she is entitled to a presumption of soundness with regard to uterine fibroids. In September 2020, she was afforded a VA examination which included a review of the claims file, medical history, and a physical examination. The examiner concluded that the Veteran's uterine fibroids first occurred in 1996, during her period of active service. Despite giving the date of onset in 1996, the examiner stated that there is no evidence in the military records that her uterine fibroids were caused by her military service. The RO subsequently issues a supplemental statement of the case stating that, although symptoms and treatment of the Veteran's uterine fibroids began in service, they were not caused by her service. Timing does not prove causation. Uterine fibroids are due simply to an excess of estrogen over progesterone, which is due to a combination of genetic predispositions and diet. The Board finds this analysis problematic. Although analysis of service connection frequently requires consideration of a causal nexus between an incident of active service, and a later diagnosed disability, the law provides that service connection may be granted for 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. The key element of the analysis here is the term "incurred in," meaning that any disability which first manifests during active service may be granted service connection if claimed. For example, if a service member were to sustain an injury in a motor vehicle accident while on leave during service, VA would still grant service connection for any residuals of that injury, despite the fact that the injury was not explicitly due to an incident of the veteran's professional military career. Likewise, were a service member to be diagnosed with diabetes during service, and that condition was not noted upon entrance and there was no evidence that it clearly preexisted service, there would be no question that it would be granted service connection and the veteran would not need to prove that some incident of service caused them to develop diabetes (indeed, 38 C.F.R. §§ 3.307 and 3.309 extend the presumptive period for that disability one year after separation). In the present matter, the evidence shows that the Veteran first developed uterine fibroids in 1996, during active service. She continued to suffer from fibroids through the earliest portion of this appeal period until she underwent a total hysterectomy in June 2015. As such, the Board is satisfied that her uterine fibroids were incurred in active service and service connection should be granted. 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 M. Pryce, Counsel