Citation Nr: 21001504 Decision Date: 01/08/21 Archive Date: 01/08/21 DOCKET NO. 17-50 505 DATE: January 8, 2021 ORDER Service connection for Graves' disease is granted. FINDING OF FACT The probative evidence of record is at least in equipoise as to whether the Veteran’s Graves’ disease is etiologically related to in-service herbicide exposure. CONCLUSION OF LAW With resolution of reasonable doubt in the Veteran’s favor, the criteria for a grant of service connection for Graves’ disease have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Navy from June 1967 to November 1968, including service in the Vietnam War. This matter is on appeal from a November 2016 rating decision. In a July 2019 decision, the Board remanded the issue being decided below to attempt to afford the Veteran an additional VA medical opinion.  The Agency of Original Jurisdiction (AOJ) has done so. Although the Board finds that the August 2019 VA medical opinion with regard to the Veteran’s Graves’ disease was inadequate, because the Board is granting the Veteran’s claim in full, any errors in compliance with remand directives with regard to this claim are harmless.  See Stegall v. West, 11 Vet. App. 268 (1998).  The Board also remanded a claim for service connection for atrial fibrillation or atrial flutter. In a March 2020 rating decision, the AOJ granted the claim. This issue is no longer before the Board. 1. Graves' Disease The Veteran contends that he has Graves’ disease that was caused by herbicide exposure during his military service. The Veteran has also raised other theories of service connection but, because this theory is dispositive, the Board will not address the Veteran’s other contentions. Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The benefit of the doubt rule provides that a veteran will prevail in a case where the positive evidence is in a relative balance with the negative evidence. Therefore, the Veteran prevails in a claim when (1) the weight of the evidence supports the claim or (2) when the evidence is in equipoise. It is only when the weight of the evidence is against the claim that the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). In a September 2013 rating decision, VA granted service connection for type II diabetes mellitus based on the Veteran’s presumed exposure to herbicides. The Board therefore presumes that the Veteran was exposed to herbicides. Certain diseases are deemed associated with herbicide exposure under current law. The list of those diseases includes hypothyroidism but does not include Graves’ disease. 38 U.S.C. § 1116(a)(2) (2021). However, a claimant is not precluded from establishing service connection with proof of actual direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). In other words, the fact that an appellant does not meet the requirements for service connection on a presumptive basis does not in and of itself preclude the establishment of service connection, as entitlement may alternatively be established on a direct basis. A January 2007 VA treatment record notes that the Veteran’s thyroid function test was hyperactive and that he probably had hyperthyroidism. The Veteran’s private treatment records during the period on appeal note a diagnosis of Graves’ disease. The Veteran has submitted a July 2019 medical opinion by his private treating endocrinologist, who cited medical literature regarding a relationship between Graves’ disease and herbicide exposure and opined that the Veteran’s Graves’ disease was more likely than not due to exposure to herbicides. The Veteran was afforded a VA medical opinion with regard to this theory of service connection in October 2020. The clinician’s opinion that it was less likely than not that the Veteran’s Graves’ disease was incurred in or caused by active duty service because his service treatment records do not document thyroid symptoms during active duty service and because Graves’ disease is not on the list of diseases deemed associated with herbicide exposure. Neither of these are adequate rationales. The medical evidence of record shows a diagnosis of Graves’ disease. With regard to the theory of service connection due to herbicide exposure, the record contains an unfavorable but inadequate VA opinion and a favorable and adequate opinion by the Veteran’s private treating endocrinologist. The record contains no adequate medical opinions that are unfavorable to the Veteran’s claim. In light of the totality of the circumstances, and after resolving all reasonable doubt in his favor, the evidence of record supports a finding that it is at least as likely as not that the Veteran’s Graves’ disease was due, at least in part, to in-service herbicide exposure. Accordingly, the Board finds that granting service connection for Graves’ disease is the decision that is the most consistent with VA’s policy to administer the law under a broad and liberal interpretation consistent with the facts of the case. 38 C.F.R. § 3.303(a). D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Ryan Frank, 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.