Citation Nr: 20046689 Decision Date: 07/13/20 Archive Date: 07/13/20 DOCKET NO. 17-47 145 DATE: July 13, 2020 REMANDED Entitlement to service connection for hypothyroidism is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from February 1962 to November 1965. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a May 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2018, the Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ); a transcript is of record. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c) (2017); 38 U.S.C. § 7107(a)(2) (2012). 1. Entitlement to service connection for hypothyroidism is remanded. The Veteran asserts that hypothyroidism had onset in service and was manifested by symptoms of hypothyroidism, to include nervousness, pin pricking sensations, profuse sweating, swollen glands, and problems swallowing. He has asserted that these symptoms have continued since service discharge. Pursuant to the Board’s July 2018 remand, the Veteran was afforded a VA contract examination in September 2019. The examiner determined the current hypothyroidism did not onset in service and is not related to service. The examiner noted in the rationale that the Veteran denied having soaking sweats and was observed to have a normal mouth and throat at separation (per the Report of Medical Examination), and private records from Kaiser Permanente dated from 2007 to 2017 do not reflect complaints of pins and needles or profuse sweating. Generally, a negative nexus opinion based entirely on a lack of documentation of symptoms in service or after, renders it inadequate. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). The Board further notes that the examiner did not comment on the Veteran’s complaint of paresthesias and nervousness in February 1964, for which he was referred to mental health counseling services (MHCS). Also, his November 1965 Report of Medical History (RMH) shows he reported nervous trouble and ear, nose, or throat trouble. The in-service report of nervousness is particularly relevant as the VA examiner has indicated the Veteran has mental and psychologic components to his hypothyroidism disorder. Furthermore, the records from Kaiser Permanente predate 2007 and reflect use of Levothyroxine since at least 2004. The matter is REMANDED for the following action: Obtain an addendum opinion regarding the etiology of the Veteran’s hypothyroidism from an appropriate clinic. The need for a physical examination is left to the discretion of the VA examiner. The examiner must review the claims file and this remand. The examiner must opine whether it is at least as likely as not (a 50 percent of greater probability) that the Veteran’s hypothyroidism has its onset in, or is otherwise related to, active service. In doing so, the examiner should discuss the likelihood of whether the symptoms noted by the Veteran during and after service were manifestations of hypothyroidism. The examiner is advised that the STRs show the Veteran complained of paresthesias and nervousness during service in February 1964 and was referred to MHCS. Also, his November 1965 RMH shows he reported nervous trouble and ear, nose, or throat trouble at discharge. A complete rationale must be provided for the opinion expressed. The rationale must consider and discuss the pertinent evidence of record, to include the Veteran’s lay statements regarding symptom onset and recurrence. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Catherynne Whitmore, 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.