Citation Nr: 21064851 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 15-13 155 DATE: October 21, 2021 REMANDED Entitlement to service connection for thyroid condition to include as a result of exposure to herbicides and/or exposure to contaminated water at Camp Lejeune is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1965 to October 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In January 2017, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In the July 2017 decision, the Board denied the Veteran's claim for entitlement to service connection for a thyroid condition. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court). On August 22, 2019, the Court dismissed the Veteran's claim on a presumptive basis and affirmed the Board's decision on a direct basis. In March 2021, the U.S Court of Appeals for the Federal Circuit vacated and remanded the United States Court of Appeals for Veterans Claims' decision. In May 2021, the United States Court of Appeals for Veterans Claims vacated and remanded the Board's July 2017 decision because the Board failed to provide an adequate statement of reasons or bases for concluding that a VA examination was not required. Entitlement to service connection for thyroid condition to include as a result of exposure to herbicides and/or exposure to contaminated water at Camp Lejeune is remanded. The Veteran contends that his thyroid condition is related to his in-service exposures to Agent Orange while serving in the Republic of Vietnam during the Vietnam War, and/or to contaminated drinking water at Camp Lejeune during training prior to his deployments overseas. The Veteran's service personnel records confirm that his active military service included duty in the Republic of Vietnam during the Vietnam War. Thus, he is presumed to have been exposed to certain tactical herbicide agents, including those found in Agent Orange, in the course of such service. See 38 C.F.R. § 3.307. The Veterans treatment records reflect that in April 2011 the Veteran's thyroid nodule has been palpated for the first time. In May 2011, the Veteran was diagnosed with a possible nodule. Specifically, the medical treatment report noted that the Veteran's condition was asymptomatic and clinically euthyroid. In August 2011, a private treatment record that indicated that the Veteran was known to have some nodules in his thyroid, felt to be related to AO exposure in Vietnam, it then immediately noted that this appointment was the first time the Veteran had mentioned this. The National Defense Authorization Act for Fiscal year 2021 added the disorders of parkinsonism, bladder cancer, and hypothyroidism, to the list of diseases presumptively associated with exposure to herbicide agents. See 38 U.S.C. § 1116(a)(2). The Board finds that although the evidence within the record does not demonstrate that the Veteran has a diagnosis of hypothyroidism, he does have a thyroid condition, and hypothyroidism is now on the presumptive list for herbicide agent exposure. The Board finds that that a VA examination was not provided for this claim. An examination is required where there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service; (3) an indication that the disability or symptoms of disability may be associated with the established in-service event, injury, or disease or with another service-connected disability; but (4) insufficient competent medical evidence on which to decide the claim. McLendon v. Nicholson, 20 Vet. App. 79, 85-86 (2006). The Board finds that the low threshold has been met, and the duty to assist was triggered to provide a VA medical examination to determine the nature and etiology of the Veteran's thyroid condition. Thus, a remand is necessary to secure a medical examination and opinion, prior to adjudication. The matter is REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any diagnosed thyroid condition. The examiner should specifically address whether the Veteran has hypothyroidism. The examiner should also opine whether each diagnosed thyroid condition is at least as likely as not (50 percent probability or greater) related to an in-service injury, event, or disease, including exposure to herbicides such as Agent Orange while serving in the Republic of Vietnam during the Vietnam War, and/or exposure to contaminated drinking water at Fort Lejeune during training prior to the Veteran's deployments overseas. The examiner should also address the Veteran's contention that he does not have a family history of any thyroid conditions. The examiner should also clarify whether any current thyroid disorder is productive of any type of disability. 2. Then, the Veteran's claim must be readjudicated. If the benefit sought on appeal is not granted to the Veteran's satisfaction, the Veteran and his representative must be provided a Supplemental Statement of the Case and be given an adequate opportunity to respond. Thereafter, the case should be returned to the Board for further appellate action. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Quist 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.