Citation Nr: 22015774 Decision Date: 03/19/22 Archive Date: 03/19/22 DOCKET NO. 16-50 285 DATE: March 19, 2022 ORDER Service connection for residuals of an ovarian cyst is denied. Service connection for oligomenorrhea, to include as secondary to residuals of an ovarian cyst, is denied. FINDINGS OF FACT 1. An ovarian cyst identified during service was normal and has resolved without residuals. 2. Oligomenorrhea did not begin during active service and is not otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for residuals of an ovarian cyst have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. 2. The criteria for service connection for oligomenorrhea, to include as secondary to residuals of an ovarian cyst, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty service with the United States Army from March 1994 to September 1995. These matters come before the Board of Veterans' Appeals (Board) on appeal of an August 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In August 2019 and July 2021, the Board remanded the claims for further development. The Board finds that the remand directives from the July 2021 remand have been substantially complied with (specifically, a November 2021 VA opinion with rationale has been obtained) and therefore will proceed with the claims. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection 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. This may be accomplished by affirmatively showing inception or aggravation during service. 38 C.F.R. § 3.303(a). Service connection may also be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be warranted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and, (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). 1. Entitlement to service connection for residuals of an ovarian cyst 2. Entitlement to service connection for oligomenorrhea, to include as secondary to residuals of an ovarian cyst The Veteran claims service connection for residuals of ovarian cysts and for oligomenorrhea. Specifically, she claims that she was diagnosed with an ovarian cyst while in service which caused irregular periods and cramps. The cyst was never removed. She claims that it developed into endometriosis and caused a miscarriage in 2003 and permanent infertility thereafter. Additionally, she claims that this caused her oligomenorrhea. The medical evidence shows that in November 1991, prior to service, the Veteran was assessed to have an imperforate hymen. Thereafter, she underwent a hymen removal procedure and was found to have an ovarian cyst during service. Post-service VA medical records reflect that the Veteran has current gynecological issues, including oligomenorrhea. A May 2013 VA examination reflected a diagnosis of oligomenorrhea, noting that the Veteran had not had a period since 2012. The examiner opined that her claimed condition was less likely than not incurred in or caused by service. The rationale stated that ovarian cysts such as the one she experienced in service are extremely common and are considered within normal limits for ovulation. The examiner additionally opined that her current gynecological residuals are not at least as likely as not related to the in-service cyst, since these cysts are common and probably occur through most women's reproductive years. Rather, the examiner opined it was more likely related to the left adnexal mass and endometriosis she experienced post-service. In a January 2020 VA medical opinion, the examiner opined that the Veteran's claimed condition was less likely than not incurred in or caused by service. The examiner stated that ovarian cysts are common findings in young women. The examiner felt that the ovarian cysts were an incidental finding which more likely was present prior to her enlistment. The examiner also noted that the Veteran was discharged in 1995 and that her symptoms resulting in surgery started in 2012. In a November 2021 VA opinion, the examiner (a gynecologist) opined that that it was less likely than not that the Veteran's current gynecological conditions had a nexus to service or represent an aggravation of a preexisting condition. The examiner noted that the Veteran was diagnosed with an imperforate hymen in 1991, prior to service. The Veteran underwent a hymenotomy and entered service reporting no significant gynecologic history and normal menses. During service, the Veteran had no gynecologic complaints, however an incidental ovarian cyst was identified on an MRI performed for right hip pain. The examiner stated that the two conditions were completely unrelated. The examiner explained that small, incidental cysts are common in reproductive-aged women. The examiner stated that a cyst would not be confused with later diagnosed conditions of endometriosis, endometrioma and hydrosalpinx. The Veteran was not diagnosed with endometriosis until late 2012 or early 2013. The Veteran did not report a change in menstrual cycle related to oral contraceptives while in service or at separation. The examiner reported that a hallmark of endometriosis is dysmenorrhea, which was not noted. There was no evidence of ongoing menstrual irregularities until 2012/2013. The examiner felt that it was medically implausible that an individual could endure such symptoms for such a span of time. Furthermore, routine gynecologic care would have identified any significant signs or symptoms during this time period. It was more likely than not that the Veteran's imperforate hymen prior to service did contribute to the ultimate diagnosis of endometriosis but this would not have been impacted by military service, including cause or aggravation. The examiner stated that all of the Veteran's conditions (endometriosis, left salpingectomy and elective tubal ligation) are consistent with the natural course of the Veteran's pre-existing condition, unaffected by service. Had endometriosis been diagnosed while in service it would have been considered coincidental to service and not secondary to service or any events in service. There were no signs or symptoms consistent with the conditions diagnosed in late 2012/2013 while in service. Regarding the ovarian cyst, the examiner stated that it had resolved and was unlikely to have been related to the ultimate diagnosis of endometriosis several years post-service. The examiner concluded that none of the Veteran's service-connected conditions played any role, including cause or aggravation of the Veteran's gynecological conditions. Upon review of all of the pertinent evidence of record, the Board finds the November 2021 VA examiner's opinion most probative on the issues. The examiner's opinion accounts for all the evidence of record and identifies when the first relevant complaints and diagnoses were made. The Board notes that, apart from the ovarian cyst (which was deemed to be normal and resolved), the Veteran's gynecological diagnoses onset years after separation from service and are unrelated to any disease or event during service. Moreover, the Board is unable to identify any complaints, symptoms, or treatment relating to a gynecological problem in service. Given that the November 2021 VA examiner's opinion is based on a review of the pertinent medical evidence, consideration of the Veteran's lay testimony, and supported by adequate rationale, the Board finds the November 2021 VA opinion to be the most probative evidence of record as to the nature and etiology of the claimed disorders. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (a medical examination report must contain clear conclusions with supporting data and a reasoned medical explanation). Lay evidence describing symptoms and time of onset, may be competent for evidence that the Veteran observed first-hand. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Here the Veteran is competent to attest to when her symptoms began. However, the Veteran is not medically trained or qualified to provide a medical nexus opinion on the etiology of her symptoms or how they may relate to any in-service illness, injury, or event. Therefore, although the Board has considered the Veteran's lay statements, the findings of the November 2021 examiner are found most probative on the issue of nexus. Based upon the above, the Board concludes that the most competent and credible evidence of record weighs against a finding that the Veteran's residuals of an ovarian cyst and oligomenorrhea are related to her military service. Rather, it is not found that the Veteran's ovarian cyst preexisted service or is directly related thereto; rather, the in-service cyst resolved and did not result in current residuals. 38 U.S.C. § 1111; 38 C.F.R. § 3.303, 3.304(b). Instead, the Veteran's current gynecological symptoms and conditions are entirely unrelated to her military service, including the in-service cyst. Given that service connection is not found for the cyst, secondary service connection cannot be established for the claimed oligomenorrhea. The preponderance of the evidence is against the claims; the benefit-of-the-doubt rule is inapplicable; and the appeals are hereby denied. Of final note, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Kate E. Kovarovic Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Henriquez, 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.