UTERUS REMOVAL OF

AMANDA G. ALDERMAN · 2026 · Case ID: A26039656

DENIED

Summary

The veteran, who served in the Army National Guard with periods of active duty from October 2008 to May 2009 and March 2021, appeals the denial of service connection for a hysterectomy, a left shoulder condition, and an acquired psychiatric disorder, including PTSD. The Board reviewed the case under the Appeals Modernization Act, noting that only evidence of record at the time of the March 2024 agency of original jurisdiction decision could be considered. The veteran elected the Direct Review docket. The Board found that the evidence persuasively weighed against service connection for the hysterectomy and left shoulder condition, as there was no indication these conditions began during service, were related to an in-service event, or were aggravated during service. For the psychiatric disorder, including PTSD, the Board found the diagnosis was not predicated on a verified in-service stressor and lacked credible evidence of an in-service event or disease conforming to DSM-5 criteria. Consequently, the Board denied service connection for all claimed conditions.

Rationale

Evidence persuasively weighs against service connection; No indication of in-service onset, relation, or aggravation

Service Branch

ARMY NATIONAL GUARD

Special Benefit

NO SPECIAL BENEFIT

Docket No.

240327-617950

Full Decision Text

Citation Nr: A26039656
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 240327-617950
DATE: April 28, 2026

ORDER

Service connection for hysterectomy is denied.

Service connection for left shoulder condition is denied.

Service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is denied.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that the Veteran's hysterectomy and left shoulder disability began during active service; are otherwise related to an in-service injury or disease; or had their onset during her period of active duty for training (ADT); resulted from a disease during any period of ADT; or is a result of an injury incurred or aggravated during her period of ADT or a period of inactive duty for training (IDT).

2. The diagnosis of PTSD is not predicated on a verified in-service stressor; there is no credible evidence of any in-service injury, event, or disease associated with a mental disorder that conforms to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5); or had their onset during her period of active duty for training (ADT); resulted from a disease during any period of ADT; or is a result of an injury incurred or aggravated during her period of ADT or a period of inactive duty for training (IDT).

CONCLUSIONS OF LAW

1. The criteria for service connection for hysterectomy are not met. 38 U.S.C. §§ 101(21), (24), 1110, 5107; 38 C.F.R. §§ 3.6(a), (c), (d), 3.102, 3.303.

2. The criteria for service connection for left shoulder condition are not met. 38 U.S.C. §§ 101(21), (24), 1110, 5107; 38 C.F.R. §§ 3.6(a), (c), (d), 3.102, 3.303.

3. The criteria for entitlement to service connection for an acquired psychiatric disorder, to include PTSD, are not met. 38 U.S.C. §§ 101(21), (24), 1110, 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.6(a), (c), (d), 3.102, 3.303, 3.304(f), 4.125.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served with the Army National Guard with periods of active duty service from October 2008 to May 2009 and from March 8, 2021, to March 29, 2021.

The rating decision on appeal was issued on March 5, 2024, and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In the March 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the March 5, 2024, agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

The issue on appeal has been more generally characterized as claim for service connection for any acquired psychiatric disorder, to include PTSD, as opposed to separate issues for those conditions, in consideration of Clemons v. Shinseki, 23 Vet. App. 1 (2009).

Preliminary Matters

The Board shall not entertain an application for review on appeal unless it conforms to the law. See 38 U.S.C. § 7108. An appeal consists of a properly completed VA Form 10182 submitted to the Board within one year from the date that the agency mails the notice of decision. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.201, 20.202, 20.203. A claimant may request an extension of the period for filing an appeal for good cause. A request for such an extension must be in writing and must be filed with the Board. Whether good cause for an extension has been established will be determined by the Board. 38 C.F.R. § 20.203.

Further, while the Board has jurisdiction over claims it has docketed, it may dismiss appeals due to procedural defects, such as noncompliance with claims processing rules. See Hall v. McDonough, 34 Vet. App. 329 (2021). Further, while the one-year deadline in 38 U.S.C. § 7105(b) to file an NOD is not a jurisdictional bar to the Board's review of a claim, "it is an important and mandatory claim-processing rule." Ferko v. McDonough, 37 Vet. App. 262, 269 (2024).

The Board finds that the Board NOD, VA Form 10182, is an untimely appeal of the claims involving: (1) hiatal hernia, (2) high blood pressure, (3) sleep apnea, (4) gout (5) bilateral hearing loss, (6) gastric condition, (7) gastroesophageal reflux disease, (8) major depressive disorder, (9) rocky mountain spotted fever, (10) skin condition, and (11) neck condition. Therefore, those claims will not be addressed in this decision as this is a claims processing defect.

Turning to the facts, the AOJ notified the Veteran of the AOJ's decisions on the Veteran's claims on the following dates: November 1, 2019, for her claim for neck condition; November 12, 2019, for her claims of (1) bilateral hearing loss, (2) gastric conditions, (3) GERD, (4) major depressive disorder, (5) Rocky Mountain Spotted Fever, and (6) skin condition; April 12, 2022, for her claim for gout, and; October 28, 2022 for her claims for (1) hiatal hernia, (2) high blood pressure, and (3) sleep apnea. See Notification Letter (November 2019, April 2022, October 2022). The notifications informed the Veteran that she had three review options if she disagreed with VA's determination. More than one year after notification of the rating decisions, the Board received in March 2024 the Veteran's Board NOD-VA Form 10182, requesting review of those same matters and the October 2019, November 2019, April 2022, and October 2022 VA decisions. The Veteran's March 2024 VA 10182 did not include a request for an extension of time to file her request for Board review or otherwise report good cause for failure to file a timely AMA review request, despite VA notifying the Veteran on April 2, 2024, of the untimely appeals and providing the Veteran an opportunity to show good cause. See BVA Untimely Appeal Letter (April 2024).

Given the above facts, the Board finds that her appeals are untimely as to the issues involving (1) hiatal hernia, (2) high blood pressure, (3) sleep apnea, (4) gout (5) bilateral hearing loss, (6) gastric condition, (7) gastroesophageal reflux disease, (8) major depressive disorder, (9) rocky mountain spotted fever, (10) skin condition, and (11) neck condition; that there is not at this time a request with good cause for an extension of time for filing of a timely VA Form 10182 as to the October 2019, November 2019, April 2022, and October 2022 VA decisions; and that fair process has been served because the Board's April 2, 2024, VA letter
) hiatal hernia, (2) high blood pressure, (3) sleep apnea, (4) gout (5) bilateral hearing loss, (6) gastric condition, (7) gastroesophageal reflux disease, (8) major depressive disorder, (9) rocky mountain spotted fever, (10) skin condition, and (11) neck condition; that there is not at this time a request with good cause for an extension of time for filing of a timely VA Form 10182 as to the October 2019, November 2019, April 2022, and October 2022 VA decisions; and that fair process has been served because the Board's April 2, 2024, VA letter notified the Veteran and her attorney that if the procedural requirements for a Board appeal were not met, consequences included inability to docket the issues for Board review and the matters will be closed.

Therefore, due to a claims processing defect, the Board will not adjudicate the matters involving (1) hiatal hernia, (2) high blood pressure, (3) sleep apnea, (4) gout (5) bilateral hearing loss, (6) gastric condition, (7) gastroesophageal reflux disease, (8) major depressive disorder, (9) rocky mountain spotted fever, (10) skin condition, and (11) neck condition.

Service Connection

Compensation may be awarded for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131. Service connection basically means that the facts, shown by evidence, establish that an injury or disease resulting in disability incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 C.F.R. § 3.303.

Service connection may be granted for any disease diagnosed after discharge, when the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). 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 Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303(a), (d).

Establishing service connection for a mental disorder for VA purposes requires diagnostic testing and a diagnosis conforming to the criteria set forth in the DSM-5. See 38 C.F.R. §§ 4.125, 4.130. The Federal Circuit held that the provisions of 38 C.F.R. §§4.125 and 4.130 unambiguously require a formal DSM-5 diagnosis as a pre-condition for service connection for a mental condition. See Martinez-Boden v. Wilkie, 32 Vet. App. 393 (2020) (holding that a diagnosis under DSM-5 is required for compensation for psychiatric disabilities).

Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (a diagnosis that conforms to the DSM-5); a link, established by medical evidence, between current symptoms and a stressor in service; and credible supporting evidence that the claimed stressor occurred. 38 C.F.R. § 3.304(f). The requirement in 38 C.F.R. § 3.304(f) for "credible supporting evidence" means that a veteran's testimony or lay statements, by themselves, cannot, as a matter of law, establish the occurrence of a noncombat stressor. See Moreau v. Brown, 9 Vet. App. 389, 394-96 (1996).

Reserve and National Guard service generally means ADT and IDT. ADT is full time duty for training purposes performed by Reservists and National Guardsmen pursuant to 32 U.S.C. §§ 316, 502, 503, 504, or 505. 38 U.S.C. § 101(22); 38 C.F.R. § 3.6(c). That usually includes two weeks of annual training and/or an initial period of training. IDT
testimony or lay statements, by themselves, cannot, as a matter of law, establish the occurrence of a noncombat stressor. See Moreau v. Brown, 9 Vet. App. 389, 394-96 (1996).

Reserve and National Guard service generally means ADT and IDT. ADT is full time duty for training purposes performed by Reservists and National Guardsmen pursuant to 32 U.S.C. §§ 316, 502, 503, 504, or 505. 38 U.S.C. § 101(22); 38 C.F.R. § 3.6(c). That usually includes two weeks of annual training and/or an initial period of training. IDT includes duty, other than full-time duty, performed for training purposes by Reservists and National Guardsmen pursuant to 32 U.S.C. §§ 316, 502, 503, 504, or 505. 38 U.S.C. § 101(23); 38 C.F.R. § 3.6(d).

With respect to Reserve and National Guard service, service connection may only be granted for disability resulting from disease or injury incurred or aggravated while performing ADT, or an injury incurred or aggravated while performing IDT. 38 U.S.C. §§ 101(24), 106, 1110, 38 C.F.R. §§ 3.6, 3.303, 3.304. Certain evidentiary presumptions do not extend to those who claim service connection based on a period of ADT or IDT. Paulson v. Brown, 7 Vet. App. 466, 470-71 (1995); Smith v. Shinseki, 24 Vet. App. 40 (2010).

Generally, no presumptions (including the presumptions of soundness, aggravation, or for presumptive diseases) attach to periods of ADT unless "veteran" status is attained during those periods. Paulson, 7 Vet. App. at 470. As to the presumption of soundness, it does not apply to a claimant who had only ADT service and who is not otherwise a veteran. Id. Even for veterans who have achieved "veteran" status through a prior period of active service and now claim a disability incurred only during a later period of ADT, the presumption of soundness applies only when the veteran has been "examined, accepted, and enrolled for service" and where that examination revealed no "defects, infirmities, or disorders." Smith, 24 Vet. App. at 45-46 (2010). In other words, there must be an entrance examination prior to the period of ADT in which the claimant claims the disease or injury occurred; otherwise, the presumption of soundness does not attach. Id. at 45-46.

1. Entitlement to service connection for hysterectomy.

2. Entitlement to service connection for left shoulder condition.

3. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD.

The Veteran contends that her hysterectomy and/or left shoulder condition had their onset in service or are otherwise etiologically related to service. She reports that her hysterectomy is due to vaccination requirements for service that caused tumors in her uterus. See VA 21-526, Fully Developed Claim (Compensation) (October 2022). The Veteran contends that her left shoulder condition resulted from a fall during military training. Id.

The Veteran contends, generally, that her mental disorders are due to an in-service event, to include getting rocky mountain spotted fever. See VA 21-526EZ, Fully Developed Claim (Compensation) (October 2023); VA 21-0781, Statement in Support of Claim for PTSD (October 2023).

The Board concludes that the criteria for service connection for left shoulder condition and hysterectomy are not met. 38 U.S.C. §§ 101(21), (24), 1110, 5107; 38 C.F.R. §§ 3.6(a), (c), (d), 3.102, 3.303.

Also, the Board concludes that the criteria for service connection for an acquired psychiatric disorder, to include PTSD, are not met. 38 U.S.C. §§ 101(21), (24), 1110, 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.6(a), (c), (d), 3.102, 3.303, 3.304(f), 4.125.

Turning to the evidence, the Veteran's period of active duty for training from October 2008 to May 2009 qualifies as active service because the Veteran established entitlement to service connection for migraine headaches and degenerative arthritis thoracolumbar spine with intervertebral disc syndrome that was incurred in the line of duty during this period of service. See Deferred Rating (October 2019). The Veteran's period of active service from March 8, 2021, to March 29, 2021, qualifies as active duty based on her April 2024 DD214. See DD214 Certified Original-Certificate of Release or Discharge from Active Duty (indicating type of separation as "Release from Active Duty" for the period of March 8, 2021, to March 29, 2021).

Service records also show that the Veteran was on active duty for training (ADT) orders from March 10, 2014, to March 14, 2014; March 10, 2014, to March 14, 2014; March 31, 2014, to April 14, 2014; April 15, 2014, to April 20, 2014; August 3, 2014, to August 8, 2014; February 14, 2018, to February 15, 2018; March 14, 2018, to March 16, 2018; April 7, 2018, to May 6, 2018; July 16, 2018, to July 20, 2018; June 7, 2019, to June 21, 2019; July 8, 2019, to July 12, 2019; July 15, 2019, to July 19, 2019; July 22, 2019, to July 26, 2019; July 13, 2020, to July 27, 2020; August 19, 2020, to September 6, 2020; September 07, 2020, to September 20, 2020; February 4, 2021, to February 26, 2021; June 4, 2022, to June 18, 2022; June 17, 2023, to July 1, 2023; October 15, 2023, to October 29, 2023. See DPRIS Response (April 2024); DPRIS Response (April 2019). The record does not contain an entrance examination for any of the Veteran's periods of ADT or IDT-to include those periods she asserts she had a specific injury. The AOJ has determined that no further records exist for the Veteran after a thorough review. See STR (April 2019); STR (May 2019); DD 2963 Service Treatment Record Transfer or Certification (May 2024). Therefore, the presumptions of soundness and aggravation do not attach. Smith, 24 Vet. App. at 45-46 (2010).

The Veteran's service treatment records (STRs) during her periods of active duty service from October 2008 to May 2009 and from March 8, 2021, to March 29, 2021, show no complaints or abnormal pathology of the left shoulder, reproductive system, or psychiatric system. A January 2009 emergency care and treatment record reflects no noted abnormalities associated with the extremities and normal evaluation of the psychiatric system. See STR at 24 (May 2019). Notably, the Veteran denies mental disability in the review of personal history during her active duty service. See STR (April 2019); STR (May 2019). Review of symptoms from October 2008 to May 2009 period of active duty service reflect the Veteran denies psychological symptoms, depression, and/or sleep disturbances, and reports normal enjoyment of activities. Id.

Reserve STRs and post service treatment records reflect treatment for the left shoulder, symptoms associated with the female reproductive system, and mental health treatment. A July 2010 statement of medical exam and duty status reveals the Veteran was mentally sound.
abnormalities associated with the extremities and normal evaluation of the psychiatric system. See STR at 24 (May 2019). Notably, the Veteran denies mental disability in the review of personal history during her active duty service. See STR (April 2019); STR (May 2019). Review of symptoms from October 2008 to May 2009 period of active duty service reflect the Veteran denies psychological symptoms, depression, and/or sleep disturbances, and reports normal enjoyment of activities. Id.

Reserve STRs and post service treatment records reflect treatment for the left shoulder, symptoms associated with the female reproductive system, and mental health treatment. A July 2010 statement of medical exam and duty status reveals the Veteran was mentally sound. See STR at 236 (April 2019). A November 2010 periodic health assessment, behavioral health questionnaire reflects the Veteran reported having little interest or pleasure in doing things for several days, trouble falling asleep and sleeping too much nearly every day, poor appetite or overeating more than half the days; however, denied feeling down, depressed, or hopeless. The Veteran reported she lost her job and could not find work. Id. at 232 (April 2019)

A February 2012, February 2013, and February 2014 Behavioral Health questionnaire reflects the Veteran denied any mental health symptoms, including little interest or pleasure in doing things or feeling down, depressed, or hopeless. Id. at 90, 136, and 165.

May 2012 private treatment record imaging results revealed a small cyst in the left ovary and suspected sub septate uterus. See Medical Treatment-Record-Non-Government Facility at 71 and 547 (April 2019). A May 2012 private treatment record reflects the Veteran was admitted to the hospital for fever, rash, headache and neck pain and reported getting a new tattoo approximately 2 weeks prior. Differential diagnosis included Rocky Mountain Spotted Fever; however, after consultation with neurology, rheumatology, hematology, and gastroenterology, the Veteran's final diagnoses were fever, rash, headache, acute viral syndrome, polyarthralgia, anemia, and history of chronic constipation. Id. at 711 and 712 (April 2019). The May 2014 Behavioral Health questionnaire reflects the Veteran denied any mental health symptoms and the Veteran reports "doing well". See STR at 43 (April 2019). The June 2014 private treatment imaging record reflects a small cyst in the left ovary and Pap Smear with HPV Reflex results reflect no intraepithelial lesions or malignancies, negative GC screening, no symptoms at the time of examination, no recommended medications, and the Veteran was cleared of any medical issue. See STR at 71 and 75 (April 2019); STR at 408 (May 2024). A CT scan of the pelvis reveals a small cyst versus dominant follicle in the right ovary. Id. at 406. A March 2017 deployment mental health assessment (MHA) reflects that the Veteran reports no major life stressors or mental health treatment or concerns over the past year. See STR at 312 (May 2024).

The January 2018, January 2019, January 2020, and July 2020 periodic health assessments (PHAs) reflect no medical conditions associated with the left shoulder since the Veteran's last PHA, no recommended surgical procedures, no medical concerns regarding women's health and/or reproductive system with exception to the January 2020 PHA in which the Veteran reports ongoing issues with heavy and/or irregular menstrual cycles/pain or premenstrual syndrome, and denies any major life stressors, treatment, or concerns for her mental health. Id. at 211, 214, 219, 237, 240, 245, 263, 266, 271, 290, and 297.

A May 2020 private treatment record reveals the Veteran presented with a left proximal humerus comminuted fracture as a result of a May 11, 2020, motor vehicle accident (MVA) that resulted in her semi-truck flipping over and denied any prior symptoms of history of injury to the left shoulder. See Medical Treatment Record-Non-Government Facility at 30 and 60 (November 2023). A May 2020 surgical operative note reveals the Veteran underwent a left proximal humerus intra-articular comminuted facture open reduction internal fixation. Id. at 98.

A January 2021 PHA reflects the Veteran denied any new health conditions since her last PHA, however reported surgery for "broken bones" and described the type of surgery as "plates", reported ongoing issues with heavy and/or irregular menstrual cycles/pain or premenstrual syndrome, however, denied any symptoms associated with an acquired psychiatric disorder. See STR at 185, 187, and 193 (May 2024). An April 2021 private treatment surgical procedure note reflects that follow up evaluation of the left shoulder found multiple fragments which resulted in mechanical block and severe pain and caused adhesive capsulitis with contracture and very limited range of motion. Surgical intervention reveals: (1) left revision open reduction internal fixation with rotational humerus osteotomy and less tuberosity transfers; (2) capsular contracture releaser of subscapularis rotator cuff; (3) autograft bone grafting; (4) hardware removal. Id. at 35. In November 2022, private treatment records revealed signs of hardware migration and loosening of screws and the Veteran underwent a surgical procedure for left proximal humorous hardware removal. Id. at 31 (November 2023).

A January 2022 PHA revealed surgery for left humerus repair since the last PHA. Id. at 127. Also, the Veteran reported having ongoing issues with heavy and/or irregular menstrual cycles/ pain or premenstrual syndrome and no abnormal pap testing performed within the past 3 years. Id. at 135. The Veteran further reported trouble sleeping, did not receive treatment for any mental health symptoms, avoided situations that remind her of upsetting experiences, felt numb or detached from others, activities, or surroundings, has little interest or pleasure in doing things more than half the days, trouble falling/staying asleep or sleeping too much nearly every day, feeling tired or having little energy nearly every day, poor appetite or overeating few or several days, and the Veteran requested mental health treatment. Id. at 130.

A May 2022 VA mental health initial assessment record reflects the Veteran reported longstanding periods of intermittent depression, anxiety, and trauma related symptoms that have come back over the last year. The Veteran was diagnosed in accordance with DSM-5 criteria for depressive disorder, generalized anxiety disorder, and PTSD. The Veteran was referred to psychiatry follow up. See CAPRI at 72, 79, and 82 (October 2022). The Veteran started individual mental health therapy in June 2022. Id. at 51.

In July 2022, VA received the Veteran's VA Form 21-526EZ disability compensation claim for service connection for PTSD. See VA 21-526EZ (July 2022).

An October 2022 VA gynecology consult endometrial biopsy revealed symptomatic uterine fibroids, iron deficiency anemia, and dysmenorrhea/pelvic pain. See CAPRI at 360 (April 2024). An October 2022 VA preop scheduling worksheet reflects the Veteran elected to undergo a robotic assisted total laparoscopic hysterectomy bilateral salpingectomy, cystoscopy, to treat the diagnosed symptomatic uterine fibroids. Id. at 357. A January 2023 VA gynecology operative report reveals the Veteran had a robotic assisted total laparoscopic hysterectomy bilateral salpingectomy, cystoscopy and the VA discharge note reveals a final diagnosis of menorrhagia. Id. at 257.

The January 2023 PHA reflects that the Veteran reports surgery since the last PHA for shoulder pain and hardware removal and health care providers recommended a hysterectomy and shoulder replacement surgery and receiving treatment for mental health symptoms, reported as nightmares, guarded and watchful, feeling numb and detached, physical reactions when reminded of stressful situations, and trouble falling and staying asleep. See STR at 68 and 71 (May 2024).

In October 2023, VA received the Veteran's VA Form 21-526EZ, disability compensation claim for left shoulder condition, hysterectomy, and mental disorder (claimed as PTSD). See VA 21-526EZ (October 2023).

A December 2023 VA treatment record reflects the Veteran underwent a motor left shoulder replacement. See CAPRI At 15 and 41 (April 2024). In the January 2024 PHA, the Veteran reports surgical procedures of hysterectomy to treat the Veteran's endometriosis and
watchful, feeling numb and detached, physical reactions when reminded of stressful situations, and trouble falling and staying asleep. See STR at 68 and 71 (May 2024).

A December 2023 VA treatment record reflects the Veteran underwent a motor left shoulder replacement. See CAPRI At 15 and 41 (April 2024). In the January 2024 PHA, the Veteran reports surgical procedures of hysterectomy to treat the Veteran's endometriosis and a shoulder replacement and receives therapy for mental health symptoms; however, denies having any symptoms associated with any mental disorder. Id. at 37 and 40.

Having carefully and sympathetically reviewed the record, the Board finds that persuasive evidence has not been presented showing that the Veteran's left shoulder condition, symptoms associated with a hysterectomy, and/or symptoms of an acquired psychiatric disorder had their onset during periods of active duty service, or are otherwise related to an in-service injury, event, or disease, incurred during a period of active duty service; or had their onset during a period of ADT, resulted from a disease during ADT; or is a result of an injury incurred or aggravated during ADT or a period of IDT.

First, the record shows that the Veteran has been diagnosed with a hysterectomy and left shoulder condition, as the March 2022 rating decision favorable findings reflect the Veteran underwent a hysterectomy in January 24, 2023, and she was diagnosed with left shoulder humerus fracture in May 2022. See Rating Decision (March 2024).

The record additionally reflects that the Veteran is diagnosed with depressive disorder, generalized anxiety disorder, and PTSD in accordance with DSM-5 criteria, as reflected in the May 2022 VA mental health initial evaluation note. See CAPRI at 79 (October 2022). Therefore, the first element of service connection is met.

Second, however, the Board finds that the evidence persuasively weighs against finding the Veteran incurred an injury to her left shoulder and/or hysterectomy during a period of active service, or during any period of ADT or IDT.

Also, the Board finds that, although the record shows a diagnosis of PTSD, this diagnosis is not predicated on any verified in-service stressor event. Indeed, the Veteran's October 2023 VA 21-0781 Statement in Support of Claim for PTSD provides no specific information or description of an in-service stressor event and only lists "Rocket Mountain Spotted Fever". The Veteran, and her attorney, is reminded that VA's duty to assist is a two-way street. If the Veteran wishes help, she cannot passively wait for it in those circumstances where she may or should have information that is essential to establishing her claim. Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Therefore, the second element of a claim for service connection for PTSD is not met. See 38 C.F.R. § 3.304(f).

Further, although the record includes private medical evidence showing that the Veteran has mental disorders other than PTSD, regardless of whether they are in accordance with the DSM-5, the Board finds that there is not credible evidence of any in-service injury, event or disease. Therefore, the second element of a claim for service connection for a mental disorder other than PTSD is not met. See 38 C.F.R. § 3.303.

Indeed, the first indication of any injury incurred during a period of active duty service, ADT, or IDT is on the Veteran's June 2022 and October 2023 VA claims for disability compensation. At that time, the Veteran reports an injury to her left shoulder as a result of a fall during military training; her hysterectomy was caused by vaccinations required for service, and; her PTSD as, generally, caused by personal trauma; however, the Veteran did not provide any specific information as to when symptoms began for the claimed conditions, any specific instance of injury resulting in the claimed conditions, or identify any specific in-service stressor event that caused the Veteran's mental disorders. See VA Form 21-526EZ (July 2022 and October 2023). She is competent to report injury, symptoms, and onset of symptoms as these are capable of lay observation. Layno v. Brown, 6 Vet. App. 465 (1994). However, to the extent that the Veteran reports onset of symptoms associated with the left shoulder, hysterectomy, and/or symptoms associated with the reproductive or psychiatric system during a period of active duty service, ADT, or IDT, the Board finds
not provide any specific information as to when symptoms began for the claimed conditions, any specific instance of injury resulting in the claimed conditions, or identify any specific in-service stressor event that caused the Veteran's mental disorders. See VA Form 21-526EZ (July 2022 and October 2023). She is competent to report injury, symptoms, and onset of symptoms as these are capable of lay observation. Layno v. Brown, 6 Vet. App. 465 (1994). However, to the extent that the Veteran reports onset of symptoms associated with the left shoulder, hysterectomy, and/or symptoms associated with the reproductive or psychiatric system during a period of active duty service, ADT, or IDT, the Board finds that this is less than credible as it is inconsistent with other evidence of record. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995) (noting that the credibility of a witness may be impeached by a showing of interest, bias, inconsistent statements, consistency with other evidence), aff'd, 78 F.3d 604 (Fed. Cir. 1996). First, her report of symptoms during active duty service are inconsistent with the Veteran's STRs, which show that no complaints, treatment, or diagnoses of the left shoulder, reproductive system, or psychiatric disorders during any period of active duty service, ADT, or IDT. Indeed, treatment records reflect the first indication of an injury to the Veteran's left shoulder immediately after the May 2020 MVA that resulted in a fracture to the left humorous; the first indication of a disability associated with the Veteran's hysterectomy is in the October 2022 VA treatment record that reveals findings of symptomatic uterine fibroids, and; the first indication of any symptoms associated with mental disorders in the January 2022 PHA. Indeed, Reserve STRs from May 2009 until the May 2020 MVA and the January 2022 PHA consistently show that the Veteran denied any symptoms associated with her left shoulder and/or mental disorders. Further, while the Veteran reports ongoing issues with heavy and/or irregular menstrual cycles/pain or premenstrual syndrome in the associated PHAs, the June 2014 Pap Smear reflects no intraepithelial lesions or malignancies, negative GC screening, no symptom at the time of examination, no medications, and the Veteran was cleared of medical issue despite presence of a small cyst on the left ovary. Indeed, onset of the left shoulder condition and symptoms associated with hysterectomy appears contemporaneous with intervening incidents of injury or disease, dated May 2020 and October 2022, further bolstering the conclusion that the claimed conditions did not begin, or are not the result of an in-service injury, event, or disease, during the Veteran's periods of active duty service, periods of ADT, or periods of IDT. Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence has greater probative value than history as reported by the claimant).

Also, the Veteran has been an inconsistent historian when addressing onset or injury to the left shoulder and symptoms of an acquired psychiatric disorder. In addressing her shoulder, the Veteran first denies a history of injury or prior symptoms associated with her left shoulder in the May 2020 private treatment record for MVA injuries. See Medical Treatment Record-Non-Government Facility at 30 (November 2023). Next, Reserve STRS reflect that the Veteran reports a "shoulder injury" that began in June 2023 while in duty status. See Medical Treatment Record-Government Facility at 14 (September 2024). Finally, in the Veteran's October 2023 VA 21-526EZ disability compensation claim, she vaguely eludes to her left shoulder condition worsening due to a fall during military training. See VA 21-526EZ, Fully Developed Claim (Compensation) (October 2023). It seems incredible that an injury to the left shoulder, particularly in consideration of the extensive surgical and therapeutic intervention since the May 2020 MVA, would be without either a Line of Duty Determination or medical documentation of the reported fall during military training.

In regard to her reports of onset of mental health, the Veteran first reports a long standing history of mental health symptoms, but reports her recent mental health symptoms began with no particular impetus one year prior to the May 2022 VA initial mental health assessment. Notably, the Veteran identified incidents of sexual assault at 8, the May 2020 MVA, and being hospitalized in 2012 with Rocky Mountain Spotted Fever as events that have caused symptoms associated with her acquired psychiatric disorders. See CAPRI at 72 (October 2022). However, the Veteran then vaguely claims that her psychiatric symptoms were caused by an in
would be without either a Line of Duty Determination or medical documentation of the reported fall during military training.

In regard to her reports of onset of mental health, the Veteran first reports a long standing history of mental health symptoms, but reports her recent mental health symptoms began with no particular impetus one year prior to the May 2022 VA initial mental health assessment. Notably, the Veteran identified incidents of sexual assault at 8, the May 2020 MVA, and being hospitalized in 2012 with Rocky Mountain Spotted Fever as events that have caused symptoms associated with her acquired psychiatric disorders. See CAPRI at 72 (October 2022). However, the Veteran then vaguely claims that her psychiatric symptoms were caused by an in-service event in her VA disability compensation claims citing to "Rocky Mountain Spotted Fever". The Board notes that in the years intervening the Veteran's May 2012 hospitalization and the January 2022 PHA, the Veteran consistently denied any major life stressors or having symptoms associated with any acquired psychiatric disorder.

Accordingly, the Veteran's statements have no persuasive or probative value and the second element of the claim for service connection is not met.

On balance, the weight of the evidence is against the claims. Specifically, the evidence of record persuasively weighs against finding that the Veteran's left shoulder condition, hysterectomy, and/or symptoms associated with an acquired psychiatric disorder had their onset during her periods of active service from October 6, 2008, to May 8, 2009, or from March 8, 2021, to March 29, 2021; or that it is otherwise etiologically related to in-service injury or disease incurred or aggravated during her periods of active service. Further, the evidence of record persuasively weighs against finding that the Veteran's left shoulder condition, hysterectomy, and/or an acquired psychiatric disorders resulted from disease or injury incurred or aggravated while performing ADT; or is a result of an injury incurred or aggravated during any period of ADT or IDT.

Accordingly, the claims are denied. As the evidence of record persuasively weighs against the claims, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (2021).

The Board acknowledges that the Veteran contends that her hysterectomy is due to tumors caused by vaccinations required for service. However, the Board finds this assertion is vague and does not clearly provide a theory of how or why required vaccinations for service caused tumors and the subsequent hysterectomy. Further, the Veteran's assertion is unsupported by any competent evidence and does not warrant further development. There is no competent and credible evidence or record suggesting any such connection, and the record does not reflect that the Veteran possesses the requisite expertise to provide any medical diagnosis or opinion on etiology, and her lay assertions, insofar as they are intended as such, are given no such weight. See Jeandreau, 492 F.3d. at 1371.

Lastly, the Board finds that the AOJ had no duty to obtain a medical opinion addressing the etiology of the claimed conditions prior to the rating decision on appeal because there is not credible evidence of any in-service injury, or symptoms associated with a left shoulder, hysterectomy, and/or mental disorders during the Veteran's active duty service, ADT, or IDT. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006); 38 C.F.R. § 3.159(c)(4).

AMANDA G. ALDERMAN

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Kenney, K. A.

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.

Analyze in VA Law Explorer