Citation Nr: 20048064 Decision Date: 07/17/20 Archive Date: 07/17/20 DOCKET NO. 18-10 682 DATE: July 17, 2020 REMANDED Entitlement to an evaluation in excess of 10 percent for thyroid cancer, status post thyroidectomy, two radical neck dissections, and radioactive iodine, with residual hypothyroidism (thyroid disability) is remanded. REASONS FOR REMAND The Veteran served on active duty from December 2007 to December 2015. This matter is before the Board of Veterans’ Appeals (Board) on appeal of a May 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In May 2020, the Veteran appeared at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is in the record. The Veteran is service connected for his thyroid disability under Diagnostic Code 7903 and receives a 10 percent rating. The Board notes that effective December 10, 2017, the rating criteria governing hypothyroidism was significantly changed. See 82 Fed. Reg. 50802 (Nov. 2, 2017). The new rating criteria depends upon the presence or absence of 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)). The Veteran’s current 10 percent rating for his thyroid disability is based upon the old rating criteria under diagnostic code 7903. The Veteran’s claim was pending prior to the effective date and is therefore considered under both the old and the new rating criteria. Whichever criteria is more favorable to the Veteran will be applied. Under the old criteria, the Veteran received a 10 percent rating because he must use continuous medication to control his hypothyroidism. A 30 percent rating required fatigability, constipation, and mental sluggishness. A 60 percent rating required muscular weakness, mental disturbance, and weight gain. A 100 percent rating required cold intolerance, muscular weakness, cardiovascular involvement, mental disturbance (dementia, slowing of thought, depression), bradycardia (less than 60 beats per minute), and sleepiness. Since the April 2016 VA examination, the Veteran testified that his symptoms have worsened with symptoms of fatigability, constipation, and mental sluggishness. The Veteran is entitled to a new VA examination where there is evidence that the condition has worsened since the last examination. 38 C.F.R. § 3.327; Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994). Accordingly, a remand is required to afford the Veteran with a new VA examination. Ongoing medical records should also be obtained. The matters are REMANDED for the following action: 1. Ask the Veteran to identify all outstanding treatment records relevant to his thyroid disability. All identified VA records should be added to the claims file. All other properly identified records should be obtained if the necessary authorization to obtain the records is provided by the Veteran. If any records are not available, or the Veteran identifies sources of treatment but does not provide authorization to obtain records, appropriate action should be taken (see 38 C.F.R. § 3.159(c)-(e)), to include notifying the Veteran of the unavailability of the records. 2. After records development is completed, schedule the Veteran for a VA thyroid examination to determine the current symptoms, level of severity, and functional impairment associated with his disability. The claims file should be reviewed by the examiner. The examiner should specifically comment on the thyroid disability based upon both the rating criteria in effect before December 10, 2017 and the current rating criteria under Diagnostic Code 7903. Specifically, the examiner is asked to comment on: (a) Whether the Veteran has fatigability, constipation and mental sluggishness. (b) Whether the Veteran has muscular weakness, mental disturbance, and weight gain. (c) Whether the Veteran has cold intolerance, muscular weakness, cardiovascular involvement, mental disturbance (dementia, slowing of thought, depression), bradycardia (less than 60 beats per minute), and sleepiness. (d) Whether the hypothyroidism manifests 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)). (Continued on the next page.) (e) All residual effects of hypothyroidism (e.g., eye, digestive, mental disorders). Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Russell P. Veldenz, 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.