Citation Nr: 21003138 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 15-06 371A DATE: January 19, 2021 ORDER Entitlement to service connection for hyperparathyroidism is granted. FINDING OF FACT Resolving all doubt in the Veteran’s favor, the Veteran’s hyperparathyroidism condition is causally related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for hyperparathyroidism have been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1986 to September 2007. The claim has been returned to the Board after an October 2019 remand. There has been substantial compliance with the remand and the Board will proceed with adjudication. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for hyperparathyroidism The Veteran contends that multiple medical complaints that she sought treatment for during service were early manifestations of her hyperparathyroidism diagnosed in 2010. The Board concludes that the Veteran has a current disability that began during active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of: (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Hickson v. West, 12 Vet. App. 247, 253 (1999). For chronic diseases listed in 38 C.F.R. § 3.309(a), the linkage element of service connection may also be established by demonstrating continuity of symptoms since service. 38 C.F.R. § 3.303(b). 38 C.F.R. § 3.307(a)(3) provides for presumptive service connection for chronic diseases that become manifest to a degree of 10 percent or more within 1 year from the date of separation from service. However, hyperparathyroidism is not listed as a “chronic disease” under 38 C.F.R. § 3.309(a); therefore, 38 C.F.R. §§ 3.303(b) and 3.309(a) do not apply. See Walker v. Shinseki, 708 F.3d 1331 (Fed.Cir.2013). The record shows that the Veteran has a current diagnosis of hyperparathyroidism. During service, she was seen for complaints of abdominal pain, nausea, gastrointestinal issues, depression, memory problems, chronic fatigue and weakness. She also experiences problems of excessive thirst, urination, and incontinence, heart palpitations, hypertension and generalized joint pain. Thus, the question for the Board is whether the current disability is related to service. On this question there are probative opinions in favor of and against the claim. The evidence against the claim includes a December 2019 VA medical opinion where the examiner opined that it is less likely than not that the Veteran’s mild primary hyperparathyroidism, diagnosed in December 2010, was due to service. The examiner also opined that hyperparathyroidism did not manifest symptoms during her military service. The examiner’s rationale supporting the opinion was that during service, the Veteran’s calcium levels were in the normal range and remained in the normal range until October 2010 when she was diagnosed with hyperparathyroidism. The examiner cited medical literature stating that most asymptomatic patients, the mean serum calcium concentration is less than 1.0 mg/dL above the upper limit of the normal range. The examiner further stated “[w]hen carefully questioned, some patients with presumed asymptomatic [primary hyperthyroidism (PHPT)] have nonspecific symptoms, such as fatigue, weakness, anorexia, mild depression, and mild cognitive or neuromuscular dysfunction. Thus, the differentiation between symptomatic and asymptomatic PHPT is not always clear-cut.” The evidence in favor of the claim includes a May 2014 private medical opinion. In the private medical opinion, the examiner said that the Veteran’s medical history reflects that the diagnosis of hyperparathyroidism was very likely delayed by several years and that the Veteran may have had hyperparathyroidism for up to possibly 10 years prior to her diagnosis. The opinion further states that in-service treatment for multiple complaints were probably symptoms directly related to her hyperparathyroidism including treatment for abdominal pain, nausea, gastrointestinal issues, depression, memory problems, chronic fatigue and weakness. She also experienced problems of excessive thirst, urination, and incontinence, heart palpitations, hypertension and generalized joint pain. The private provider also opined that had the Veteran been treated by a single provider, her diagnosis of hyperparathyroidism would most likely have been made earlier. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current hyperparathyroidism incurred during or is related to her service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for hyperparathyroidism is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. G. Perkins, 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.