Citation Nr: 20043435 Decision Date: 06/26/20 Archive Date: 06/26/20 DOCKET NO. 14-35 122A DATE: June 26, 2020 REMANDED Entitlement to an initial rating in excess of 30 percent for hypothyroidism is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1991 to September 1999, from November 2004 to April 2006, from May 2006 to August 2007, and from July 2008 to September 2009. This matter initially came before the Board of Veterans’ Appeals (Board) on appeal from a March 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Phoenix, Arizona. The Veteran originally appealed the claimed listed above as well as a claim of entitlement to service connection for hypertensive vascular disease. In a November 2018 decision, the Board denied service connection for hypertensive vascular disease and remanded the claim for an increased initial rating for hypothyroidism for further evidentiary development. The Veteran’s hypothyroidism was initially assigned a 10 percent rating. During the pendency of the appeal, the RO has increased that initial rating to 30 percent. Because a higher rating is available during the entire appeal period, and because the Veteran is presumed to seek the maximum available benefit, the claim for a higher initial rating remains on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); AB v. Brown, 6 Vet. App. 35 (1993). Entitlement to an initial rating in excess of 30 percent for hypothyroidism is remanded. The Veteran’s hypothyroidism is rated under DC 7903. See 38 C.F.R. § 4.119. Under that DC, a 30 percent rating is warranted for hypothyroidism without myxedema, and a 100 percent rating is warranted for hypothyroidism manifesting as myxedema (cold intolerance, muscular weakness, cardiovascular involvement (including, but not limited to hypotension, bradycardia, and pericardial affusion), and mental disturbance (including, but not limited to dementia, slowing of thought and depression)). Note (2) under DC 7903 provides that a 30 percent evaluation shall continue for six months after the initial diagnosis. Thereafter, VA must rate residuals of the disease or medical treatment under the most appropriate diagnostic code(s) under the appropriate body system (e.g., eye, digestive, mental disorders). Here, the Veteran has been rated at 30 percent throughout the appeal period; it does not appear that he has ever been separately rated for symptoms as indicated under Note (2), above. In its November 2018 remand, the Board determined that an updated VA examination was needed given the Veteran’s contentions that his hypothyroidism had worsened since his last examination. Thereafter, the Veteran underwent an examination in September 2019. In the report, the examiner stated that the Veteran suffered from fatigue, sleeping difficulty, and hypogonadism; however, there was no mention of whether the Veteran’s disease manifested as myxedema. Following the examination, the Veteran’s representative submitted an Informal Hearing Presentation essentially arguing that the examination was incomplete. In light of the rating criteria of DC 7903, the Board agrees that the September 2019 VA examination was incomplete. An additional examination is required which fully addresses all relevant symptoms under the appropriate DCs. See Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007) (when VA undertakes to provide a medical examination or obtain a medical opinion, it must ensure that the examination or opinion is adequate). The matters are REMANDED for the following action: Schedule the Veteran for an examination to determine the nature and severity of his hypothyroidism. The examiner is specifically asked to detail the nature of the findings, signs, and symptoms of the disease. The examiner should specifically discuss whether the Veteran’s hypothyroidism has manifested as myxedema at any point during the appeal period. If indicated by the examination findings, the Veteran should be separately examined for residual effects of hypothyroidism within the appropriate body system (e.g., eye, digestive, and mental disorder). LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Ryan, Associate Counsel 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.