Citation Nr: 18140102 Decision Date: 10/02/18 Archive Date: 10/02/18 DOCKET NO. 15-36 719 DATE: October 2, 2018 ORDER Entitlement to service connection for a heart condition as secondary to the Veteran’s service connected Grave’s disease with insomnia, anxiety, and fatigue is denied. Entitlement to an increase rating greater than 60 percent, from April 7, 2011, for the Veteran’s service connected Grave’s disease with insomnia, anxiety, and fatigue is denied. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of a heart condition. 2. The Veteran’s Grave’s Disease with insomnia, anxiety, and fatigue has not been reasonably shown to present thyroid enlargement, tachycardia, eye involvement, muscular weakness, loss of weight, and sympathetic nervous system, cardiovascular, or gastrointestinal symptoms. CONCLUSIONS OF LAW 1. The criteria for service connection for a heart condition secondary to the Veteran’s service connected Grave’s disease with insomnia, anxiety, and fatigue are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). 2. The criteria for a rating exceeding 60 percent for Grave's Disease, from April 7, 2011, have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.119, Diagnostic Codes 7900. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1983 to June 1992. The Veteran appeals an April 2013 rating decision from the Department of Veteran Affairs (VA) Regional Office (RO) in Waco, Texas. Secondary Service Connection The Veteran asserts that his heart condition is due to, or aggravated by his service connected Grave’s disease with insomnia, anxiety, and fatigue. Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical 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). Service connection is also warranted for disability proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Such secondary service connection is warranted for any increase in severity of a current nonservice-connected disability that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease. 38 C.F.R. § 3.310 (b). Service connection based on aggravation caused by a service-connected disability is limited to situations when the baseline level of severity of the nonservice-connected disability is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. Id. In August 2017, the Veteran stated that his service treatment records indicated the presence of a heart condition. Upon review of the evidence, the Board notes that the Veteran does not have a present disability involving a heart condition. Although the Veteran’s service treatment records show a provisional diagnosis of cardiac dysrhythmia, and cardiac arrhythmia in the late 1980s. Both provisional diagnoses were ruled out while in service. The Veteran was checked out for a possible enlarged heart, but it was determined that the heart was normal, and not enlarged. Further, a December 2007 VA physician note stated that the Veteran does not have a heart problem. Finally, a March 2014 echocardiogram did not find a present heart disability. Consequently, because there is no current disability there can be no claim. See Brammer v. Derwinski, 3 Vet. App. 223 (1992) (without proof of a present “disability” there can be no claim; regardless of injuries or diseases sustained in active service). Therefore, the claim must be denied. Increased Rating The Veteran contends that he is entitled to non-initial increase rating exceeding 60 percent from April 7, 2011, for his service connected Grave’s disease with insomnia, anxiety, and fatigue. Disability evaluations are determined by comparing the Veteran’s present symptomatology with the criteria set forth in the VA’s Schedule for Ratings Disabilities. 38 U.S.C. § 1155; 38 C.F.R. § Part 4. Higher ratings are assigned if the disability more nearly approximates the criteria for that rating; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence the benefit of the doubt is to be resolved in the Veteran's favor. 38 U.S.C. § 5107(b). The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings,” whether it is an initial rating case or not. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Here, the Board does not find staged ratings necessary. Hyperthyroidism is rated under 38 C.F.R. § 4.119, Diagnostic Code 7900. Under Diagnostic Code 7900, hyperthyroidism with tachycardia, which may be intermittent, and tremor, or continuous medication required for control is rated 10 percent disabling. Hyperthyroidism with tachycardia, tremor, and increased pulse pressure or blood pressure is rated 30 percent disabling. A 60 percent rating is appropriate where there is hyperthyroidism with emotional instability, tachycardia, fatigability, and increased pulse pressure or blood pressure. Where there is thyroid enlargement, tachycardia (more than 100 beats per minute), eye involvement, muscular weakness, loss of weight, and sympathetic nervous system, cardiovascular, or gastrointestinal symptoms, the disability is rated 100 percent disabling. 38 C.F.R. § 4.119. Hypothyroidism is rated under 38 C.F.R. § 4.119, Diagnostic Code 7903. Under DC 7903, a 10 percent rating is warranted for fatigability, or; continuous medication required for control. A 30 percent rating is warranted for fatigability, constipation, and mental sluggishness. A 60 percent rating is warranted for muscular weakness, mental disturbance, and weight gain. A 100 percent rating is warranted for cold intolerance, muscular weakness, cardiovascular involvement, mental disturbance (dementia, slowing of thought, depression), bradycardia (less than 60 beats per minute), and sleepiness. A September 2012 VA medical note attributed the Veteran’s complaints of his “heart racing” to anxiety/panic. The Veteran was afforded a VA examination in March 2013. The VA examiner diagnosed the Veteran with hyperthyroidism and hypothyroidism. During the examination, the Veteran stated that he had heart palpitations, hypertension, tremors, eye symptoms, anxiety/depression, weight loss, and chills. The March 2013 VA examiner recorded that the Veteran had the following hyperthyroid symptoms: increased pulse or blood pressure, tremor, emotional instability, fatigability, muscular weakness, increase sweating, flushing, and heat intolerance. The Veteran did not have thyroid enlargement, weight loss, tachycardia, or eye involvement. Regarding hypothyroidism, the March 2013 VA examiner opined that the Veteran had the following hypothyroid symptoms: muscular weakness, and cold intolerance. The VA examiner did not find bradycardia. Additionally, the VA examiner stated the Veteran’s eyes were normal with no exophthalmos. The Veteran’s pulse was regular, heart rate at 93, blood pressure at 158/101. The Veteran’s neck was normal with no palpable thyroid enlargement or nodules. In April 2013, the Veteran stated that he lost his thyroid after radiation treatments. A March 2014 VA medical note reported weight loss. In 2015 VA medical notes, the Veteran reported having panic attacks with a racing heart rate. The Veteran asserted he becomes depressed and anxious when he anticipates having racing heart rates again. Finally, no thyroid enlargement was noted. In 2016, VA medical notes reported the Veteran’s heart had a regular rhythm and rate. In an August 2016 VA medical note, no thyroid enlargement was noted. In a December 2016 VA neurology clinic note the Veteran had regular heart rhythm and rate, and no weakness. In January 2017, no thyroid enlargement was noted. In June 2017, a VA medical note reported that the Veteran has a history of excessive daytime sleepiness, and fatigue. In October 2017, the Veteran was afforded another VA examination. The October 2017 VA examiner noted that the Veteran had the following symptoms of hyperthyroidism: cardiovascular and gastrointestinal symptoms, intermittent tachycardia, increased blood pressure, tremor, emotional instability, fatiguability, increase sweating, and frequent bowel movements. The Veteran had the following symptoms of hypothyroidism: fatiguability, cardiovascular involvement, and constipation. The Veteran did not have symptoms reflecting hyperparathyroidism. The Veteran had normal eyes with no exophthalmos, and neck without palpable thyroid enlargement or nodules. The Veteran had a regular pulse, and a heart rate of 72. The Veteran’s blood pressure was 156/94. The October 2017 VA examiner stated, in a February medical addendum opinion, that since the Veteran does not have a thyroid, the Veteran’s symptoms would be due to conditions other than the thyroid. Based on the above, the Veteran is not warranted a rating exceeding 60 percent under DC 7900. The Veteran does have cardiovascular symptoms such as a racing heart, increased blood pressure, and tachycardia. The March 2013 VA examination reported muscular weakness. A VA medical note reported weight loss in the Veteran. However, the evidence of record shows the Veteran had a normal heart rate and pulse on numerous occasions. Further, the Veteran’s eyes were reported as normal with no exophthalmos. Finally, the October 2017 VA examiner, and the Veteran in April 2013, reported that the Veteran no longer had a thyroid. As such, the Board can infer that the Veteran could not have an enlarged thyroid. Even if thyroid enlargement was possible, VA medical records from 2015, 2016, and 2017 noted no thyroid enlargement. Therefore, a 100 percent rating under DC 7900 is not warranted. See 38 C.F.R. § 4.118, DC 7900. The March 2013 and October 2017 VA examiners stated the Veteran did not have signs or symptoms of hypoparathyroidism, or hyperparathyroidism. As such, a higher rating under DC 7904 and 7905 is not warranted. See 38 C.F.R. § 4.118, DC 7904, 7905. Neither is the Veteran entitled to a rating for hypothyroidism. See 38 C.F.R. § 4.118, DC 7903. The March 2013 VA examination reported cold intolerance. As mentioned above, the Veteran suffers from panic attacks, anxiety, and sleepiness. Also, the record shows muscular weakness, and cardiovascular involvement. However, the VA medical records, and March 2013 and October 2017 VA examinations do not show the presence of bradycardia. Therefore, a 100 percent rating under 7903 is not warranted. Consequently, a rating greater than 60 percent for the Veteran’s Grave’s disease is not warranted. A 60 percent disability for hyperthyroidism will cause the Veteran many problems. The only question is the degree of the problem based on the criteria above. (Continued on the next page)   Finally, neither the Veteran nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record with regards to these claims. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming the Board is not required to address issues raised by the claimant or reasonably raised by the evidence of record). This finding does not, in any way, suggest that the Veteran does not have problems with his thyroid. JOHN J. CROWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Timothy A. Campbell, Associate Counsel