Citation Nr: 21042151 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 14-40 822 DATE: July 12, 2021 ORDER Service connection for a gynecological disorder, to include uterine fibroids, adenomyosis and menorrhagia is granted. REMANDED The issue of service connection for eustachian tube dysfunction is remanded. FINDING OF FACT The Veteran's gynecological disorder is related to uterine fibroids diagnosed during service. CONCLUSION OF LAW The criteria for service connection for a gynecological disorder to include uterine fibroids, adenomyosis, and menorrhagia 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 June 1995 to August 1995; from June 1996 to December 1996; from December 2003 to February 2005; January 11-31, 2010; from April 2010 to January 2011; and from May 30, 3015 to June 12, 2015 with additional periods of reserve service. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the appeal for additional development in August 2018. Service connection for a gynecological disorder, to include uterine fibroids, adenomyosis and menorrhagia. The Veteran contends that her uterine fibroids and adenomyosis is related to her treatment of such during service. The Board has broadened the claim to any gynecological disorder that may be reasonably encompassed by the Veteran's description of the claim, the Veteran's symptoms, and other information of the record, so as not to improperly limit the claim. See Clemons v. Shinseki, 23 Vet. App. 1, 6, (2009). The Veteran has a current disability that is related to treatment received from the same during service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). A September 2011 VA examination report noted the Veteran had fibroids with adenomyosis. During service, the Veteran was seen and diagnosed with fibroids. Thus, the question becomes whether the current disability is related to service. On this question there are probative opinions in favor of and against the claim. The evidence against the claim includes a December 2019 medical opinion that the Veteran's disorder was not related to service, clearly and unmistakably pre-existed service with no aggravation and was not secondary to her service-connected disabilities. The opinion addressing the Veteran's claim on a direct basis was simply a conclusory statement without any supported rationale. The same is reflected in the examiner's opinion that the Veteran's fibroids pre-existed service and was not aggravated beyond its natural progression by service. The examiner did not provide a basis for the conclusion that the disorder pre-existed service. The examiner also failed to provide an opinion on aggravation of the Veteran's gynecological disorder by the Veteran's service-connected disabilities. The evidence in favor of the claim includes service treatment records that note upon enlistment into service in February 1995, the Veteran had no gynecological disorder or symptoms on her report of medical examination. The Veteran claims she has had excessive bleeding and severe cramps during her monthly menstrual cycle since her military training in 2003. In October 2010, service treatment records show the Veteran's complaints of pain under the umbilicus that occurred in the line of duty. In November 2010, the Veteran was seen again for complaints of abdominal pain and cramps for 2 months, with heavy menstruations. The examiner noted she had unresolved pelvic pain and she was diagnosed with having an enlarged uterus. December 2010 private treatment records note the Veteran had pelvic pain with irregular menstruations and she was diagnosed with fibroids located on the right side of her uterus and was prescribed medication for her excessive bleeding. Service treatment records dated beginning in January 2011 continued to note the Veteran had an enlarged uterus with pelvic pain. In December 2017 service treatment records reflect the Veteran's complaints of pelvic pain and uterine enlargement. August 2017 private treatment records show the Veteran's diagnosis of uterine fibroids and menorrhagia. A December 2019 VA medical opinion also notes the Veteran's uterine fibroids were at least likely as not related to service. The evidence is in balance as to whether the Veteran's current gynecological disorders arose in service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND The issue of service connection for eustachian tube dysfunction is remanded. The matter is REMANDED for the following action: 1. BACKGROUND FOR THE RO ADJUDICATOR: There has not been substantial compliance with the Board's previous remand directives regarding the issue. Another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). In the August 2018 Board decision, the RO was instructed to obtain a medical opinion about whether the Veteran had a current diagnosis of eustachian tube dysfunction and whether the disability was caused or aggravated by service or a service-connected disability. The findings of a December 2019 VA examination and several opinions are not consistent. Some opinions note the Veteran did not have a diagnosis of eustachian tube dysfunction while others seem to indicate that the Veteran has a diagnosis of eustachian tube dysfunction that is not related to service or a service-connected disability. None of these opinions contain adequate rationale and do not provide a clear depiction of the nature and etiology of the Veteran's claimed disorder. A remand is required to obtain an adequate opinion on the nature and etiology of the Veteran's eustachian tube dysfunction in compliance with previous remand directives. The remand directives follow. 2. Schedule the Veteran for an appropriate VA examination for her eustachian tube dysfunction. The electronic file, including a copy of the Remand, must be reviewed by, the VA examiner. All appropriate tests, studies, and consultations must be done, and all clinical findings must be reported in detail. Based upon a review of the relevant evidence of record, history provided by the Veteran, and sound medical principles, the VA examiner should provide the following opinions: (a.) Whether the Veteran currently has an eustachian tube dysfunction, previously diagnosed in 2007 or had the condition resolved prior to the filing of the Veteran's claim in July 2011? (b.) If the Veteran has a current diagnosis, the examiner should opine whether the Veteran's eustachian tube dysfunction was caused by or aggravated by any in-service event, injury, or disease? (c.) Whether the Veteran's eustachian tube dysfunction was caused by or aggravated by any service-connected disability? The examiner is advised: He/she must fully explain the opinions. A summary conclusion is not sufficient under the law and the opinion will be returned for further clarification. THE EXAMINER MUST ALSO EXPRESS AN OPINION OF WHETHER THE VETERAN'S ACCOUNT OF THE DEVELOPMENT OF THE DISABILITIES IS CONSISTENT WITH THE MEDICAL EVIDENCE AND THE EXAMINER'S KNOWLEDGE AND PRACTICE EXPERIENCE. The examiner must review the entire record in conjunction with making the requested opinions. IN ADDITION TO ANY RECORDS THAT ARE GENERATED BECAUSE OF THIS REMAND, the VA examiner's attention is drawn to the following: *In March 2005, VA treatment records noted the Veteran past medical history included a diagnosis of allergic rhinitis and hearing stuffiness. *In May 2007, the Veteran was seen by her private otolaryngologist for complaints of decreased hearing with a stopped-up sensation and occasional plugged-up feeling that had persisted for about a year. The physician noted the Veteran had a small mass in the left tail of the parotid region. The private physician diagnosed the Veteran with rhinitis, eustachian tube dysfunction and a parotid tumor. *The September 2011 VA examination report noted that symptoms of rhinorrhea can cause eustachian tube blockage. *Service connection is in effect for tinnitus, rhinitis, and residuals of status post parotidectomy. 3. After the above development, readjudicate the issue on appeal. If the benefits sought on appeal are denied, the Veteran and her representative should be supplied a supplemental statement of the case (SSOC). An appropriate period should be allowed for response before the case is returned to the Board. Vito A. Clementi Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. McDuffie, 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.