190418-18477, 190418-18477

Background

Veteran served on active duty in the U.S. Army from April 1981 to April 1984 and appealed an April 2019 RO decision to the Board; she requested a Board hearing and testified in April 2021.
Claim issues: service connection for ovarian cyst / residuals of hysterectomy / scarring; back disorder; tinnitus; right foot condition; left foot condition.
Service treatment records (STRs) note gynecologic visits, episodes of lower abdominal pain (including a possible ectopic pregnancy), and corns on both feet; separation exam showed normal ears and denied ongoing back or hearing problems.
Post-service records show ongoing gynecologic disease (endometriosis, ovarian cysts, fibroids), multiple gynecologic surgeries culminating in total hysterectomy and removal of an ovarian neoplasm, spine degenerative disease with radiculopathy, MRI findings, and bilateral hammertoe surgery.
VA examiners (October 2018) generally provided negative nexus opinions for the back, tinnitus, and foot claims; a VA gynecology exam plus a private physician’s statement and the record produced a roughly balanced evidentiary picture for the gynecologic claim.
Board outcomes: service connection granted for ovarian cyst, residuals of hysterectomy, and scarring (based on equipoise/benefit of the doubt); service connection denied for back condition, tinnitus, right foot, and left foot (VA medical opinions and lack of in-service or continuity evidence favored denial).

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Service connection — ovarian cyst, hysterectomy, scarring	Veteran: continuous gynecological problems beginning in service led to cysts, scarring, infertility, and eventual hysterectomy; private physician links post-service disease to in‑service events	VA/Board: STRs lack clear chronic diagnosis in service; VA examiner found nexus less likely than not though some post‑service records document disease	Granted (evidence in relative equipoise; benefit of the doubt applied)
Service connection — back disorder	Veteran: back pain began in service from carrying heavy equipment and continued since	VA/Board: STRs do not show chronic or compensable back condition in service or within presumptive period; October 2018 VA nexus opinion negative	Denied (medical evidence weighs against service connection)
Service connection — tinnitus	Veteran: tinnitus began in service after a grenade explosion and caused vertigo and ear pain	VA/Board: STRs and separation exam normal; Veteran gave inconsistent onset statements; VA examiner found tinnitus onset after service and nexus less likely than not	Denied (inconsistent lay statements and negative medical nexus)
Service connection — right foot (hammertoe)	Veteran: corns in service progressed to hammertoes requiring surgery	VA/Board: STRs document corns but not hammertoes in service; VA examiner found insufficient evidence tying current hammertoes/arthritis to in‑service corns	Denied (medical evidence does not link current condition to service)
Service connection — left foot (hammertoe, degenerative arthritis)	Veteran: same as right foot; ongoing pain and need for orthotics	VA/Board: no in‑service documentation of hammertoes; VA nexus opinion negative	Denied (medical evidence does not link current condition to service)

Key Cases Cited

Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004) (explaining the nexus requirement for service connection)
Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (continuity of symptomatology for establishing chronic disease service connection)
Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (limits on lay competency to provide medical etiology opinions)
Nieves‑Rodriguez v. Peake, 22 Vet. App. 295 (Vet. App. 2008) (requirements for adequate medical rationale and when an examiner’s opinion is probative)
Gilbert v. Derwinski, 1 Vet. App. 49 (Vet. App. 1990) (benefit‑of‑the‑doubt rule in veterans claims)
Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001) (application and limits of the benefit‑of‑the‑doubt rule)