Citation Nr: A20008804 Decision Date: 05/18/20 Archive Date: 05/18/20 DOCKET NO. 200310-68916 DATE: May 18, 2020 ORDER Entitlement to a compensable rating for hypothyroidism is denied. FINDING OF FACT Throughout the period on appeal the Veteran’s hypothyroidism has been controlled with continuous medication and has not manifested as myxedema or any other residual signs or symptoms. CONCLUSION OF LAW The criteria for entitlement to a compensable initial disability for hypothyroidism have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.102, 4.119, Diagnostic Code 7903.   REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1961 to September 1968, and from November 1968 to February 1971. Rating Disability ratings are determined by applying the criteria set forth in the VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity resulting from disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2017). Where there is a question as to which of two disability ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. 1. Hypothyroidism Service connection for hypothyroidism was granted in a January 2020 rating decision and the VA Regional Office assigned a non-compensable rating effective December 19, 2018. The Veteran seeks a compensable rating. The Veteran’s hypothyroidism is rated under Diagnostic Code 7903. Under the current version of Diagnostic Code 7903, effective December 10, 2017, a 100 percent rating is assigned for hypothyroidism manifesting as myxedema (cold intolerance, muscular weakness, cardiovascular involvement (including, but not limited to hypotension, bradycardia, and pericardial effusion), and mental disturbance (including, but not limited to dementia, slowing of thought and depression)) for a period of six months after an examiner has determined the condition is stabilized. Note (1) appending the 100 percent criteria states that this evaluation shall continue for six months beyond the date that an examining physician has determined crisis stabilization. Thereafter, the residual effects of hypothyroidism shall be rated under the appropriate diagnostic code(s) within the appropriate body system(s) (e.g., eye, digestive, and mental disorders). A 30 percent rating is assigned for hypothyroidism without myxedema. Note (2) appending the 30 percent criteria states that this evaluation shall continue for six months after initial diagnosis. Thereafter, rate residuals of disease or medical treatment under the most appropriate diagnostic code(s) under the appropriate body system (e.g., eye, digestive, mental disorders). Note (3) states that if eye involvement, such as exophthalmos, corneal ulcer, blurred vision, or diplopia, is also present due to thyroid disease, also separately evaluate under the appropriate diagnostic code(s) in §4.79, Schedule of Ratings – Eye (such as diplopia (DC 6090) or impairment of central visual acuity (DCs 6061-6066)). See 38 C.F.R. § 4.119, Diagnostic Code 7903. The Veteran was assigned a 0 percent noncompensable rating pursuant to 38 C.F.R. § 4.31, which states that in every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. See 38 C.F.R. § 4.31. The RO explained that the Veteran is asymptomatic and had no compensable symptoms of hypothyroidism. See January 2020 Rating Decision; April 2020 Rating Decision. After reviewing the evidence of record, the Board concludes a compensable rating for hypothyroidism is not warranted. The Veteran was afforded a VA thyroid conditions examination in July 2019. The Veteran reported that his hypothyroidism started over 20 years ago and that he had been on medication since. He visits his primary care physician once a year for hypothyroidism management. He reported that his hypothyroidism had gotten worse since onset which has resulted in an increase in the dosage for his medication. He stated he currently takes Synthroid every day and that his thyroid is currently managed well with medication. The examiner noted that there were no current symptoms of hypothyroidism. The Veteran did not have any findings, signs or symptoms attributable to a thyroid condition. The Veteran’s eyes were normal, and his neck was normal with no palpable thyroid enlargement or nodules. His pulse was regular, and his blood pressure was 147/91. All his reflexes were recorded normal. Benign or malignant neoplasm or metastases related to any of the thyroid condition was not found. Laboratory testing performed in July 2019 showed normal results. The examiner determined that, despite normal lab values, the Veteran has a previous diagnosis of hypothyroidism and is on thyroid medication, therefore, diagnosis is maintained. See July 2019 VA Examination Report. The Veteran was afforded another VA thyroid conditions examination in December 2019. The Veteran reported that routine blood work revealed hypothyroidism and that he had been on replacement therapy since about 1990. He has been on the same dose of Synthroid for many years and his current dose is 225 micrograms per day. The examiner noted that there were no current symptoms of hypothyroidism. The Veteran did not have any findings, signs or symptoms attributable to a thyroid condition. The Veteran’s eyes were normal. His neck was normal with no palpable thyroid enlargement or nodules. His pulse was regular, and his blood pressure was 135/70. All his reflexes were recorded normal. Benign or malignant neoplasm or metastases related to any of the thyroid condition was not found. Laboratory testing performed in July 2019 showed normal results. The examiner concluded that the Veteran was asymptomatic on examination for hypothyroidism. See December 2019 VA Examination Report. The examiner’s findings are not contradicted by any of the other evidence of record. The medical records are silent as to whether the Veteran has any residual symptoms attributable to his hypothyroidism. VA medical records show a history of hypothyroidism and that he has been prescribed replacement medication for at least 20 years. The Veteran is heavy, and he wears glasses, but neither has been attributed to hypothyroidism.   The Veteran’s hypothyroidism is not productive of myxedema, and as such, a 100 percent rating for 6 months after stabilization is not warranted. The Board notes that the Veteran’s hypothyroidism was diagnosed in 1990, many years prior to his December 2018 claim. Thus, the criteria for a 30 percent disability rating for hypothyroidism without myxedema are also not met, as a 30 percent disability rating under Diagnostic Code 7903 is only applicable for 6 months after initial diagnosis. 38 C.F.R. § 4.119. Although the Veteran is not entitled to a compensable rating under Diagnostic Code 7903, any residuals of hypothyroidism may be rated under separate diagnostic codes. See 38 C.F.R. § 4.119, Diagnostic Code 7903. However, none of the lay or medical evidence suggests the Veteran experiences residuals of hypothyroidism. The Veteran has not identified any symptoms or residual disabilities he believes are attributable to his hypothyroidism. VA examiners have not attributed any symptoms to hypothyroidism. On the contrary, VA examiners have determined his hypothyroidism is asymptomatic and controlled with medication. The Veteran’s eyes were normal in both VA examinations, and although the Veteran wears glasses, no examiner or other medical professional has attributed his vision disability to hypothyroidism. The remaining medical evidence shows that his VA doctors have not attributed any residual symptoms or disabilities to hypothyroidism. No separate rating for residuals of hypothyroidism is warranted. The preponderance of the evidence is against a compensable disability rating for hypothyroidism. Ultimately, the Board places the most probative weight on the results of the physical examinations by medical professionals which show no evidence of compensable residuals of hypothyroidism to warrant higher or separate   disability ratings. The Veteran has not alleged that he has specific residuals of hypothyroidism, nor does the medical evidence of record show any residual. Because the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Morse 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.