Citation Nr: 18142987 Decision Date: 10/17/18 Archive Date: 10/17/18 DOCKET NO. 16-05 476 DATE: October 17, 2018 ORDER Service connection for hypothyroidism is denied. FINDING OF FACT The Veteran’s hypothyroidism was not caused or aggravated by active service. CONCLUSION OF LAW The criteria to establish service connection for hypothyroidism have not been met. 38 U.S.C. §§ 11101, 1110, 1112, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1997 to May 2001. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2013 rating decision issued by the RO. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.30(d). 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). “Congress specifically limits entitlement to service-connected disease or injury to cases where such incidents have resulted in a disability. In absence of proof a present disability there can be no valid claim.” Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992). The Veteran contends that service connection is warranted for hypothyroidism. She alleges that symptoms began during service and have continued since service separation. In her September 2012 claim, she argues that in-service anthrax medications caused her disorder. A December 1997 service department medical questionnaire indicates the Veteran then denied having, or ever having had depression or thyroid trouble. Similarly, the Veteran was noted to have denied these symptoms in a November 2000 questionnaire. Clinical evaluation detected no relevant abnormalities. The Veteran argues that she had in-service depressive symptoms which indicated the onset of her disorder. Her service treatment records indicate that the Veteran complained of depressed mood and emotional irritability in late 2000. However, these symptoms were attributed to “situational” factors. In a December 2000 note, military medical care providers noted that the Veteran had a depressed mood and emotional instability due to a “strained marriage” and that one month before the writing of the note, there was an incident of “infidelity.” Service treatment records do not indicate a diagnosis for hypothyroidism nor any other cause of her depressive symptoms. Laboratory results from September 2011, December 2011, February 2011, and April 2012 post-service medical record reflected high levels of thyroid stimulating hormone (TSH), leading to the initial diagnosis of hypothyroidism and the initiation of treatment. In June 2013, the Veteran submitted internet articles regarding hypothyroidism. As indicated by the Veteran, these articles reflect that the early stages of hypothyroidism seldom cause symptoms. Further, the articles include that when symptoms manifest they often include depression and constipation. At a VA examination in December 2013, a VA examiner diagnosed hypothyroidism and noted that the Veteran has been on continuous medication as treatment since July 2011. However, the VA medical examiner found that the Veteran’s hypothyroidism was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner reported that there were “no medical indications” that the Veteran’s thyroid disorder began during her service, and found that the current disorder was unrelated to her reported in-service constipation and depression. Taken together, the preponderance of the evidence is against the claim. The Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a 3-step inquiry. First, the Board must determine whether the evidence comes from a “competent” source. The Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303 at 308 (2007) (observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible). The third step of this inquiry requires the Board to weigh the probative value of the proffered evidence considering the entirety of the record. Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159. Lay evidence may be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition (i.e., when the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer); (2) the layperson is reporting a contemporaneous medical diagnosis, or; (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). The Veteran’s expressed opinion that in-service symptoms were the onset or cause of her disorder is not competent, and a medical nexus opinion as to the etiology of the Veteran’s hypothyroidism has not been submitted. Moreover, there is no competent evidence indicating that the Veteran’s disorder was caused by any in-service inoculation. (Continued on the next page)   The Veteran has argued that she should be granted the benefit of the doubt. However, without medical nexus evidence, a grant of service connection would be speculative and the benefit of the doubt doctrine is not applicable based on pure speculation or remote possibility. See 38 C.F.R. § 3.102. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. T. Emmart, Associate Counsel