Citation Nr: 21066200 Decision Date: 10/28/21 Archive Date: 10/28/21 DOCKET NO. 17-50 116 DATE: October 28, 2021 ORDER Entitlement to an initial 100 percent rating for hypothyroidism, euthyroid multinodular goiter (hypothyroidism) is granted, subject to the laws and regulations governing the award of monetary benefits. FINDING OF FACT Symptoms of the Veteran's hypothyroidism have more nearly approximated cold intolerance, muscular weakness, mental disturbance, and sleepiness. CONCLUSION OF LAW The criteria for an initial disability rating of 100 percent for hypothyroidism have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.1, 4.3, 4.119, Diagnostic Code (DC) 7903 (as in effect prior to December 10, 2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1983 to April 1987 and from January 1989 to July 1994. This matter comes before the Board of Veterans' Appeals (Board) from an October 2013 rating decision, which granted service connection and assigned an initial disability evaluation of 60 percent to the Veteran's service-connected hypothyroidism, effective April 16, 2013, the date of the claim. The Board remanded the case in March 2020. As the Board is granting the benefit sought in full, discussion of remand compliance is unnecessary. Increased Ratings Disability evaluations are assigned to reflect levels of current disability. The appropriate rating is determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Each service-connected disability is rated on the basis of specific criteria identified by Diagnostic Codes. 38 C.F.R. § 4.27. The degrees of disability specified are considered adequate to compensate for a loss of working time proportionate to the severity of the disability. 38 C.F.R. § 4.1. When there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Initial Rating Higher than 60 percent for hypothyroidism. The Veteran contends that the initial 60 percent disability rating assigned for her service-connected hypothyroidism does not adequately reflect the severity of her symptoms. The period on appeal begins on April 16, 2013, the effective date of the award of service connection for hypothyroidism. Hypothyroidism is rated under 38 C.F.R. § 4.119, DC 7903. VA amended the criteria for rating hypothyroidism, effective December 10, 2017. See Schedule for Rating Disabilities; The Endocrine System, 82 Fed. Reg. 50802 (Nov. 2, 2017). Where, as here, where a regulation changes after a claim has been filed but before the appeal process has been concluded, the version of the law most favorable to the claimant should apply, except that the amended version of the regulation generally does not apply prior to its effective date. Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991); VAOPGCPREC 7-2003 (Nov. 19, 2003). In this case, the Board will apply the former version of the regulation, as the maximum schedular 100 percent rating is warranted under the prior version of DC 7903 for the following reasons. Prior to December 10, 2017, under Diagnostic Code 7903, a 10 percent rating is assigned when hypothyroidism is manifested by fatigability, or continuous medication is required for control. A 30 percent rating requires fatigability, constipation, and mental sluggishness. A 60 percent rating requires muscular weakness, mental disturbance, and weight gain. A 100 percent rating requires cold intolerance, muscular weakness, cardiovascular involvement, mental disturbance (dementia, slowing of thought, depression), bradycardia (less than 60 beats per minute), and sleepiness. In an October 2013 VA examination, the Veteran reported to the VA examiner that she was on continuous medication to control the symptoms of hypothyroidism and that her dose of Synthroid medication prescribed to control her symptoms had recently been increased from 100 mcg to 125 mcg. She indicated that she experienced chronic fatigue, hair loss, low libido, weight gain and irritability. She also reported symptoms of fatigability, constipation, mental disturbance, weight gain and sleepiness. In a subsequent VA examination conducted in March 2016, the VA examiner noted that the Veteran had reported experiencing symptoms of dry skin, mood swings, low sex drive, hair thinning, fatigue, voice change, muscular weakness, and fatigability. The Veteran stated that she often feels worn and experiences mood swings. The VA examiner characterized the severity of the Veteran's symptoms was "moderate." The Veteran indicated that her dosage of Synthroid medication had recently been increased from 100mcg to 125 mcg per day. She also reported recently losing approximately 25 pounds. In a May 2016 statement, the Veteran indicated that she still suffered from chronic fatigue, depression, muscular weakness, and weight gain. A May 2016 letter from a private physician, indicated that if the Veteran were to stop taking medication, her symptoms would return including the goiter, chronic fatigue, cold intolerance, weight gain, decreased concentration, muscle weakness and constipation. The physician indicated that without her medication, the Veteran would also experience weight fluctuations and noted that the Veteran had reported voice hoarseness and episodes of fatigue. In an August 2017 statement, the Veteran indicated that she felt tired daily and found it was hard to get out of bed. She also reported having chronic muscle pain, including leg pain that kept her from sleeping. She stated that she had an inability to focus and experienced anxiety and stress. She reported having heart flutters that cause her to be winded, depression, thinning hair, crying, and no libido. She stated that, due to fatigue, she often falls asleep during meetings at work. September 2017 private treatment records indicate that the Veteran's physician documented a change in the Veteran's energy level, weight changes and changes in her tolerance for heat and cold. At that time, the Veteran denied diarrhea and palpitations. A September 2020 treatment record reflects that the Veteran reported to the VA examiner that she was experiencing dry skin, weight gain, intermittent hoarseness, mood swings, hair loss, fatigue, and a low sex drive. In a September 2020 statement, the Veteran indicated that she has often feels tired and unproductive and has to take naps during breaks at work due to fatigue and she was experiencing an increased sensitivity to cold. The symptoms of the Veteran's hypothyroidism have consistently included cold intolerance, mental disturbance, and sleepiness. Although the Veteran has not displayed each of the symptoms listed in the criteria for a 100 percent rating under the prior version of DC 7903, for example she has not had bradycardia, the symptoms have more nearly approximates the criteria required for the 100 percent rating. See 38 C.F.R. § 4.7. Accordingly, the criteria for a 100 percent initial rating for hypothyroidism effective April 16, 2013, have been met. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. K. Donaldson, 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.