BENIGN NEOPLASMS OF THE GYNECOLOGICAL SYSTEM OR BREAST

Summary

The Veteran served on active duty from December 2018 to October 2020. The Veteran appeals the denial of service connection for endometriosis and seeks service connection for hemorrhagic ovarian cysts, claiming both conditions are related to an in-service Nexplanon birth control device implantation. The Board considered the claim for hemorrhagic ovarian cysts under the doctrine of Clemons v. Shinseki, broadening the scope of the original claim for endometriosis. Evidence included in-service records showing Nexplanon implantation, post-service VA treatment records noting abnormal uterine bleeding and pelvic pain, and a November 2024 private clinician's report suggesting possible endometriosis but finding results not definitive. A November 2024 VA examiner also could not confirm a diagnosis of endometriosis via laparoscopy or MRI. The Board found the evidence in approximate balance regarding hemorrhagic ovarian cysts, affording the Veteran the benefit of the doubt and granting service connection. For endometriosis, the Board found the evidence insufficient, noting the absence of a diagnosis close in proximity to the claim or during service, and the lack of definitive findings from private or VA examinations. Service connection for endometriosis was denied.

Rationale

Clemons v. Shinseki broadened claim scope to include hemorrhagic ovarian cysts; Evidence in approximate balance; Benefit of the doubt afforded to Veteran

Full Decision Text

Citation Nr: A26040994
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 250313-524843
DATE: April 30, 2026

ORDER

Service connection for hemorrhagic ovarian cysts is granted.

Service connection for endometriosis is denied.

FINDINGS OF FACT

1. The Veteran has hemorrhagic ovarian cysts related to her service. 

2. There is no indication of a diagnosis of endometriosis close in proximity to, or during, the pendency of the claim. 

CONCLUSIONS OF LAW

1. The criteria for service connection for hemorrhagic ovarian cysts are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for endometriosis are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from December 2018 to October 2020.

The Veteran filed a new November 2024 claim seeking service connection for endometriosis. The agency of original jurisdiction (AOJ) issued a February 2025 rating decision denying the claim. In the March 2025 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 February 2025 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 claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Service Connection

Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service.  38?U.S.C. §?1110; 38?C.F.R. §?3.303.

The term "disability" under 38 U.S.C. § 1110 refers to the functional impairment of earning capacity not the underlying cause of said disability. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018).

1. Service connection for hemorrhagic ovarian cysts

In Clemons v. Shinseki, the Court of Appeals for Veterans Claims (Court) held that when a veteran submits a claim, he or she is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled. 23 Vet. App. 1, 6 (2009).  Accordingly, pursuant to Clemons, the Board has broadened the scope of the claim of service connection for endometriosis to include a claim of service connection for bilateral hemorrhagic ovarian cysts.

The Veteran contends that she has a current disability of hemorrhagic ovarian cysts due to being implanted with a Nexplanon birth control device during her service. See November 2024 Claim. 

Service treatment records note that the Veteran received implantation of the Nexplanon device on January 16, 2019, during her active duty service. 

Post service VA treatment records note the following relevant findings: On December 10, 2020 the Veteran is noted to have abnormal heavy uterine bleeding, occurring about every other month, for a two week duration. On January 14, 2021 the Veteran is still noted to have abnormal uterine bleeding. On June 1, 2024 it is noted that the Veteran has pelvic and low back pain, and that she was informed by another provider based on a pelvic sonogram that she has bilateral hemorrhagic ovarian cysts with rupture. 

On October 3, 2024 the Veteran is noted to have a slightly heterogeneous uterus echotexture, and a 3.4 cm right ovarian cyst. On October 14, 2024 the Veteran is noted to have a 2.3 x 2.0 cm hypodense lesion on the
erine bleeding, occurring about every other month, for a two week duration. On January 14, 2021 the Veteran is still noted to have abnormal uterine bleeding. On June 1, 2024 it is noted that the Veteran has pelvic and low back pain, and that she was informed by another provider based on a pelvic sonogram that she has bilateral hemorrhagic ovarian cysts with rupture. 

On October 3, 2024 the Veteran is noted to have a slightly heterogeneous uterus echotexture, and a 3.4 cm right ovarian cyst. On October 14, 2024 the Veteran is noted to have a 2.3 x 2.0 cm hypodense lesion on the right ovary, which may be a mildly complex hemorrhagic cyst. On October 29, 2024 the Veteran reported she had pelvic and low back pain that was a 9 on a scare from 1-10. The Veteran reported that the pain is constantly present but increased with movement and could be alleviated by rest. Id.

A November 2024 private clinician noted that a pelvic MRI showed that the T2 dark thickening of the uterine and bilateral ovarian serosa. The clinician found that definitive T1 hyperintensity of subacute hemorrhagic products is absent, which may be due to long-term use of Nexplanon. Id. The clinician found that overall, findings are suggestive but not definitive for deep pelvis endometriosis.

A November 2024 VA examiner noted that the Veteran reported having a history of low back and abdominal pain as well as extended menstrual cycles. 

Based on the disability picture presented by the above relevant evidence and affording the benefit of the doubt to the Veteran, the evidence is at least in approximate balance as to whether the Veteran developed hemorrhagic ovarian cysts after in-service placement of Nexplanon which has led to pain and abnormal heavy uterine bleeding (functional impairment) since separation. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

2. Service connection for endometriosis

The Veteran contends that she has endometriosis which had its onset during service. Specifically, the Veteran contends that she has endometriosis due to the implantation of a birth control device, Nexplanon, during service. See November 2024 Claim. 

However, there is no indication of a diagnosis of endometriosis close in proximity to, or during, the pendency of the claim. See November 2024 Private Clinician Report; November 2024 VA Examination Report. 

The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 104 F. 3d 1328 (1997). In the absence of proof of a present disability there can be no valid claim. While the Board recognizes the Veteran's general contention that she has endometriosis related to her military service, the record does not show, nor does the Veteran contend, that she has the specialized education, training, or experience that would qualify her to diagnose herself with endometriosis. 

The Board notes that under current regulations, a diagnosis of endometriosis must be substantiated by laparoscopy. See 38 CFR 4.116 Diagnostic Code 7629. 

Post treatment records include an opinion by a Dr. S. S. which indicates that upon examination, the Veteran had hemorrhagic cysts, but that the doctor was more concerned that they might actually be endometriomas. However, no diagnosis for endometriosis was rendered by this doctor. 

The Veteran submitted a November 2024 private clinician's opinion that the results of a pelvic medical resonant imaging (MRI) show possible endometriosis, but the results were not definitive. A November VA examiner opined that she was unable to confirm diagnosis per laparoscopy or MRI of pelvis. As such, the evidence is currently insufficient to show a current disability.

As the evidence is not in approximate balance for the service connection claim endometritis, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107(b). Accordingly, the appeal is denied as to this matter. 

 

 

S. C. Krembs

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Jackson, Atossa K.

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. 


 service connection claim endometritis, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107(b). Accordingly, the appeal is denied as to this matter. 

 

 

S. C. Krembs

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Jackson, Atossa K.

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.