VAGINAL DISEASE OF

B. MULLINS · 2026 · Case ID: 26001291

GRANTED

Summary

The veteran, who served honorably in the United States Navy from March 1979 to March 1985, appeals the denial of service connection for several gynecological and urinary tract conditions. The case has a complex procedural history, involving multiple remands from the Board of Veterans' Appeals and the United States Court of Appeals for Veterans Claims (CAVC) due to inadequate VA examinations. The veteran initially sought compensation under 38 U.S.C. § 1151 for complications from transobturator tape placement, including sling erosion. Service connection for chronic urinary incontinence was subsequently granted on a direct basis, rendering the § 1151 claim moot. The primary issue on appeal was whether atrophic vaginal mucosa, grade 1 cystocele, sling erosion, and female sexual arousal disorder were secondarily service-connected due to aggravation by the service-connected chronic urinary incontinence. The Board reviewed multiple VA examinations, some of which provided negative nexus opinions or were deemed inadequate. However, a February 2025 VA examination concluded that while direct service connection was not established, it was at least as likely as not that the conditions were aggravated by the service-connected chronic urinary incontinence. The Board found the evidence in approximate balance, affording the veteran the benefit of the doubt, and granted service connection for all four conditions as secondary to chronic urinary incontinence.

Rationale

Evidence in approximate balance; Benefit of the doubt afforded; Aggravated by service-connected chronic urinary incontinence

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

16-24 030A

Full Decision Text

Citation Nr: 26001291
Decision Date: 01/29/26 Archive Date: 01/29/26

DOCKET NO. 16-24 030A
DATE: January 29, 2026

ORDER

Entitlement to service connection for atrophic vaginal mucosa to include as secondary to chronic urinary incontinence is granted.

Entitlement to service connection for grade 1 cystocele to include as secondary to chronic urinary incontinence is granted.

Entitlement to service connection for sling erosion to include as secondary to chronic urinary incontinence is granted.

Entitlement to service connection for female sexual arousal disorder to include as secondary to chronic urinary incontinence is granted.

FINDING OF FACT

1. The competent evidence of record shows that it is at least as likely as not that the Veteran's atrophic vaginal mucosa was aggravated by her service-connected chronic urinary incontinence.

2. The competent evidence of record shows that it is at least as likely as not that the Veteran's grade 1 cystocele was aggravated by her service-connected chronic urinary incontinence.

3. The competent evidence of record shows that it is at least as likely as not that the Veteran's sling erosion was aggravated by her service-connected chronic urinary incontinence.

4. The competent evidence of record shows that it is at least as likely as not that the Veteran's female sexual arousal disorder was aggravated by her service-connected chronic urinary incontinence.

CONCLUSION OF LAW

1. The criteria for establishing entitlement to service connection for atrophic vaginal mucosa to include as secondary to chronic urinary incontinence have been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

2. The criteria for establishing entitlement to service connection for grade 1 cystocele to include as secondary to chronic urinary incontinence have been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

3. The criteria for establishing entitlement to service connection for sling erosion to include as secondary to chronic urinary incontinence have been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

4. The criteria for establishing entitlement to service connection for female sexual arousal disorder to include as secondary to chronic urinary incontinence have been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served honorably in the United States Navy from March 1979 to March 1985.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from

an August 2013 rating decision issued by the Department of Veterans Affairs (VA)

Regional Office (RO). It was previously before the Board in June 2020 at which

time entitlement to compensation under 38 U.S.C. § 1151 for complications of

transobturator tape placement, including sling erosion, was denied.

The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (CAVC), which resulted in a March 2021 joint motion for remand (JMR) agreed to by the parties. By way of a March 2021 order, CAVC remanded the matter to the Board for compliance with the instructions in the JMR.

The matter was again before the Board in August 2021, May 2022, November 2022, and December 2023. Each time it was remanded to address inadequate VA examinations. In August 2024, the Board expanded the Veteran's claim to include entitlement to service connection for a gynecological/urinary tract condition on a direct basis and remanded for an opinion regarding direct service connection. In June 2025, service connection for chronic urinary incontinence was granted and the Board again remanded for an opinion regarding direct service connection.

The Veteran initially sought compensation under 38 U.S.C. § 1151 for complications of transobturator tape placement, to include sling erosion. As noted above, the Board expanded the Veteran's claim to include direct service connection and granted service connection for chronic urinary incontinence on a direct basis. As compensation for a direct-incurrence service-connected disability is a greater benefit than compensation under 38 U.S.C. § 115
to include entitlement to service connection for a gynecological/urinary tract condition on a direct basis and remanded for an opinion regarding direct service connection. In June 2025, service connection for chronic urinary incontinence was granted and the Board again remanded for an opinion regarding direct service connection.

The Veteran initially sought compensation under 38 U.S.C. § 1151 for complications of transobturator tape placement, to include sling erosion. As noted above, the Board expanded the Veteran's claim to include direct service connection and granted service connection for chronic urinary incontinence on a direct basis. As compensation for a direct-incurrence service-connected disability is a greater benefit than compensation under 38 U.S.C. § 1151, the granting of the service connection for chronic urinary incontinence on a direct service connection basis rendered the issue of whether compensation is warranted under 38 U.S.C. § 1151 moot. See Hornick v. Shinseki, 24 Vet. App. 50, 53-55 (2010) (examining the different ancillary benefits available to service-connected veterans compared to those receiving compensation under section 1151 and observing that section 1151 does not accord service-connected status to a veteran's disability or death).

Service connection.

Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303 (a).

Establishing service connection generally requires (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F. 3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table); 38 C.F.R. § 3.303.

Service connection may also be granted for any disease diagnosed after the military discharge, when all the evidence, including that pertinent to the period of military service, establishes that the disease was incurred during the active military service. 38 U.S.C. § 1113 (b); 38 C.F.R. § 3.303 (d).

Service connection may also be established on a secondary basis for a disability which is proximately due to, or aggravated by, a service-connected disease or injury. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310. In order to prevail on the theory of secondary service connection, there must be evidence of a current disability; evidence of a service-connected disability; and evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether evidence persuasively weighs against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the Veteran.

1. Entitlement to service connection for atrophic vaginal mucosa to include as secondary to chronic urinary incontinence is granted.

The Veteran seeks service connection for a gynecological/urinary tract condition.

She initially sought compensation under 38 U.S.C. § 1151 for complications of

transobturator tape placement, to include sling erosion. As noted above, the Board

expanded the Veteran's claim to include direct service connection.

The Board is granting service connection for chronic urinary incontinence on a

direct basis. As compensation for direct-incurrence service-connected disability is

a greater benefit than compensation under 38 U.S.C. § 1151, the issue of whether

compensation is warranted under 38 U.S.C. § 1151 is moot. See Hornick v.

Shinseki, 24 Vet. App. 50, 53-55 (2010) (examining the different ancillary benefits

available to service-connected veterans compared to
§ 1151 for complications of

transobturator tape placement, to include sling erosion. As noted above, the Board

expanded the Veteran's claim to include direct service connection.

The Board is granting service connection for chronic urinary incontinence on a

direct basis. As compensation for direct-incurrence service-connected disability is

a greater benefit than compensation under 38 U.S.C. § 1151, the issue of whether

compensation is warranted under 38 U.S.C. § 1151 is moot. See Hornick v.

Shinseki, 24 Vet. App. 50, 53-55 (2010) (examining the different ancillary benefits

available to service-connected veterans compared to those receiving compensation

under section 1151 and observing that section 1151 does not accord service-

connected status to a veteran's disability or death).

The Veteran contends that her atrophic vaginal mucosa was aggravated by her service-connected chronic urinary incontinence. Having carefully reviewed the evidence of record, and considering all pertinent laws and regulations, the Board finds that the Veteran's contention is warranted.

As stated previously, secondary service connection requires a showing of a current disability, evidence of a service-connected disability, and evidence establishing a connection between the service-connected disability and the current disability. The October 2025 VA examiner confirmed the diagnoses atrophic vaginal mucosa, grade 1 cystocele, sling erosion, and female sexual arousal disorder and a June 2025 Board order granted service-connection for chronic urinary incontinence. Thus, the first two elements of secondary service connection have been met. The remaining issue to be decided is whether there is a causal connection between the Veteran's atrophic vaginal mucosa and her chronic urinary incontinence.

The Veteran attended a VA examination in December 2021. The examiner diagnosed the Veteran with urinary incontinence. The Veteran reported that the onset of her urinary incontinence was in 1981 after the birth of her first child. Upon review of the claim file, the examiner found that the Veteran's complications from her transobturator tape placement surgery, to include sling erosion, were not the result of carelessness, negligence, lack of skill, or fault on the part of her VA care team. The examiner did find that the transobturator tape placement surgery resulted in a worsening of her conditions, particularly her urinary incontinence.

The Veteran was afforded a VA examination in February 2022. The examiner concluded that a review of the medical evidence shows that the treatment provided by the VA met the expected standard of care, all accepted protocols were followed, and all treatment was appropriate. The examiner further found that the Veteran's complaints of worsening symptoms post her May 2010 surgery are subjective and not supported by evidence. However, the examiner did state that she was not a gynecological or urological practitioner and these issues would be better addressed by someone who was a gynecological or urological expert.

The VA conducted a review of the record in February 2022. The file was reviewed by a general practice physician who specializes in obstetrics and gynecology. The examiner reviewed the entire claim file, including the records from the May 2010 transobturator tape placement, and concluded that it is less likely than not that the VA medical team failed to meet the expected standard of care in all facets of the Veteran's treatment. The examiner opined that the treatment rendered by the VA did not result in any additional separate residual conditions. The examiner found that all residuals are related to the Veteran's acknowledged diagnoses and the surgical procedures to treat the Veteran's diagnoses.

The VA conducted a review of the record in August 2022. The examiner indicated that there was no evidence to support a complication of transobturator tape placement to include sling erosion. The examiner found no evidence of a skin condition and no findings, signs, or symptoms to support a diagnosis. The examiner did opine that the Veteran's female sexual arousal disorder was due to pain arising from the Veteran's transobturator tape placement surgery.

The VA conducted a second review of the record in August 2022. A separate examiner found that the Veteran was diagnosed with urinary incontinence, atrophic vaginal mucosa, and female sexual arousal disorder. After reviewing the evidence or record, the examiner concluded that it less likely than not that these disabilities were the fault of the VA or due to an unforeseeable event.

The VA conducted a review of the record in December 2022. The examiner found that the Veteran suffered from urinary incontinence, atrophic vaginal mucosa, and grade 1 cystocele which led to sling erosion surgery in May 2010 and a sling removal procedure in September 2011. Addressing the claimed additional disabilities identified as increased urinary incontinence and female sexual arousal disorder arising from the May 2010 or September 2011 surgeries, the examiner opined that the evidence of record shows that it is less likely than not that the Veteran's additional disability was the result of faulty care by the VA or an event that was not reasonably foreseeable. The examiner further opined that it is less likely than not that any additional disability the Veteran suffered was caused or aggravated by her VA treatment or an event not reasonably foreseeable. The examiner stated that there is no evidence that the VA did not exercise the degree of care that would be expected of a reasonable health care provider.

The VA conducted a review of the record in December 2023. The examiner found that the Veteran had been diagnosed with urinary incontinence and female sexual arousal disorder. The examiner opined that there is no evidence that the treatment rendered by the VA caused, aggravated, or worsened the Veteran's conditions. Further, the examiner opined that it is less likely than not that the Veteran's conditions resulted from a reasonably foreseeable event. The examiner further found that it is less likely than not that the Veteran's conditions were caused, aggravated, or worsened by the sling surgery in 2010 or her sling removal surgery in 2011. Finally, the examiner opined that it is less likely than not that the Veteran's urinary incontinence and female sexual arousal disorder arose as a result of the VA failing to properly treat the Veteran.

The Veteran attended a November 2024 VA examination. The examiner diagnosed the Veteran as suffering from urinary incontinence and opined that it is less likely than not that the Veteran's urinary incontinence is related to the Veteran's military service. The examiner indicated there are no documented complaints of urinary issues until April 2010. The examiner acknowledged that the Veteran was diagnosed with cervicitis and a urinary tract infection in 1980, but there is no medical literature that supports the proposition that these conditions can lead to the development of urinary incontinence so many years later.

The examiner who conducted the November 2024 VA examination additionally prepared a January 2025 medical report in which the examiner opined that it is less likely than not that conditions atrophic vaginal mucosa, female sexual arousal disorder, sling erosion, grade 1 cystocele, status post total hysterectomy, and bilateral salpingo-oophorectomy were caused by the Veteran's military service. The examiner found that these conditions arose after the Veteran's dates of service. Specifically, the examiner found that the Veteran reported that these conditions were caused by her May 2010 sling surgery. As the surgery and the conditions arose after the Veteran's discharge from service, the examiner opined that it is less likely than not that the Veteran's atrophic vaginal mucosa, female sexual arousal disorder, sling erosion, grade 1 cystocele, status post total hysterectomy, and bilateral salpingo-oophorectomy arose during her dates of service.

The VA conducted a review of the evidence of record in February 2025. The examiner diagnosed the Veteran as suffering from urinary stress incontinence, urinary dysfunction, presence of urogenital implant, sling erosion, and female sexual arousal disorder. Considering the Veteran's in-service exposure to herbicides, the examiner opined that it less likely than not that any of these diagnoses were caused by the Veteran's toxic exposures considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. The examiner found that current medical literature does not support a connection between the development of the diagnosed conditions and exposure to herbicides including tetrachlorodibenzodioxin (TCDD).

The VA conducted a review of the medical evidence of record in October 2025. The examiner confirmed the diagnoses atrophic vaginal mucosa, grade 1 cystocele, sling erosion, and female sexual arousal disorder. Addressing whether these conditions were directly caused by the Veteran's service connected chronic urinary incontinence, the examiner opined against service connection. However, the examiner did opine that it is at least as likely as not that the conditions atrophic vaginal mucosa, grade 1 cystocele, sling erosion, and female sexual arousal disorder were aggravated beyond their natural progression by the Veteran's service-connected chronic urinary incontinence. In support of his conclusion, the examiner found that urinary incontinence is associated with increased sexual complaints, including low libido, vaginal dryness, and dyspareunia. The examiner indicated that these symptoms are more common in women with pelvic floor disorder. Further, urinary incontinence can contribute to atrophic changes in the vaginal mucosa and pelvic floor laxity, which may manifest as cystocele. The examiner also stated that sling erosion is a common complication following surgery for urinary incontinence.

The Board acknowledges the lay evidence of record and the Veteran's contentions that her atrophic vaginal mucosa, grade 1 cystocele, sling erosion, and female sexual arousal disorder were aggravated by her service-connected chronic urinary incontinence. To the extent that the Veteran has described her symptoms and their onset, the Board finds the Veteran credible. A Veteran is competent to report on that of which he or she has personal knowledge. Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, the Veteran is not competent to opine as to the etiology of her atrophic vaginal mucosa, grade 1 cystocele, sling erosion, or female sexual arousal disorder. The issue of secondary causation is a medical determination outside the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

When the October 2025 VA examination and the Veteran's statements are balanced against the negative VA reports of record, the evidence is, at a minimum, equally balanced on this issue. As such, the Board finds the evidence is at least in approximate balance as to whether the Veteran's service-connected chronic urinary incontinence aggravated the Veteran's atrophic vaginal mucosa, grade 1 cystocele, sling erosion, and female sexual arousal disorder. Accordingly, resolving all reasonable doubt in favor of the Veteran, service connection for atrophic vaginal mucosa, grade 1 cystocele, sling erosion, and female sexual arousal disorder as secondary to chronic urinary incontinence is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

2. Entitlement to service connection for grade 1 cystocele to include as secondary to chronic urinary incontinence is granted.

See 1 above.

3. Entitlement to service connection for sling erosion to include as secondary to chronic urinary incontinence is granted.

See 1 above.

4. Entitlement to service connection for female sexual arousal disorder to include as secondary to chronic urinary incontinence is granted.

See 1 above.

B. MULLINS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Litts, Norman W. Jr

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.

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