10-13 725
10-13 725
Board of Vet. App.May 8, 2017Background
- Veteran served active duty Feb 1991–Apr 1995 and seeks service connection for residuals of a total abdominal hysterectomy with bilateral salpingo-oophorectomy performed in Oct 2002.
- Service records show treatment for gynecologic issues (HPV, cervical dysplasia, cervicitis) and complaints of pelvic/groin pain during service.
- The 2002 hysterectomy was performed for chronic pelvic pain and menometrorrhagia; post‑op care requires ongoing hormonal therapy.
- A May 2007 VA examiner opined the hysterectomy was unrelated to in‑service cervical dysplasia and attributed the procedure to post‑service menometrorrhagia/chronic pelvic pain (onset post‑delivery in 2002).
- After a Board remand, a June 2015 supplemental opinion found it less likely than not that in‑service pelvic complaints caused or aggravated the post‑service pelvic pain that led to the 2002 hysterectomy, noting orthopedic diagnoses in service and a multi‑year gap to first post‑service gynecologic symptoms.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Entitlement to service connection for residuals of hysterectomy | Hysterectomy residuals are related to or aggravated by service‑time gynecologic/pelvic problems | Medical evidence shows no causal nexus or aggravation; in‑service symptoms attributed to orthopedic conditions and post‑service onset tied to childbirth | Denied — preponderance of evidence against service connection |
Key Cases Cited
- Scott v. McDonald, 789 F.3d 1375 (Fed. Cir.) (Board must satisfy statutory/regulatory notice and duty‑to‑assist standards)
- Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir.) (elements required for service connection)
- Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir.) (lay evidence competency limits)
- Hickson v. West, 12 Vet. App. 247 (Vet. App.) (service connection evidence principles)
- Caluza v. Brown, 7 Vet. App. 498 (Vet. App.) (requirements for VA to consider service‑medical evidence)
- Gonzales v. West, 218 F.3d 1378 (Fed. Cir.) (Board need not discuss every piece of evidence)
- Kahana v. Shinseki, 24 Vet. App. 428 (Vet. App.) (limitations on lay opinion on medical etiology)
- Gilbert v. Derwinski, 1 Vet. App. 49 (Vet. App.) (benefit‑of‑the‑doubt rule)