Citation Nr: A21016993 Decision Date: 10/20/21 Archive Date: 10/20/21 DOCKET NO. 210514-160737 DATE: October 20, 2021 ORDER Entitlement to a separate 10 percent rating, but no higher, for hypothyroidism status post partial thyroidectomy with hoarseness of voice is granted. FINDING OF FACT During the appeal period, the manifestations of the Veteran's hypothyroidism most closely approximated a noncompensable rating under Diagnostic Code (DC) 7903 and a 10 percent rating under DC 6516. CONCLUSION OF LAW The criteria a separate 10 percent rating under DC 6516, but no higher, for hypothyroidism status post partial thyroidectomy with hoarseness of voice have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.7, 4.97, DC 6516, 4.119, DC 7903 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had qualifying service from July 1967 to October 1987. In an April 2021 Rating Decision, the Agency of Original Jurisdiction (AOJ) denied the issue herein. On May 14, 2021, VA received a VA Form 10182 (Board Appeal Notice of Disagreement), in which the Veteran elected Board review of the April 2021 Rating Decision through the Evidence Submission Docket under the modernized review system pursuant to the Appeals Modernization Act (AMA). 84 Fed. Reg. 138, 177 (Jan. 18, 2019) (to be codified at 38 C.F.R. § 19.2(d)). In a May 2021 letter, VA notified the Veteran that his appeal had been placed on the Evidence Submission Docket. The Evidence Submission Docket only permits the Board to review the evidence: (a) of record at the time of the AOJ decision on appeal; (b) submitted with the VA Form 10182; or (c) submitted within 90 days following VA's receipt of the VA Form 10182. 84 Fed. Reg. 138, 177 (Jan. 18, 2019) (to be codified at 38 C.F.R. § 19.2(d)). If the Veteran wishes to submit evidence outside the periods allowed by the Evidence Submission Docket, then he may file a Supplemental Claim and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. Under the AMA, the reasons for remand are limited to: (a) correction of pre-decisional duty to assist errors; and (b) correction of an AOJ error in satisfying a regulatory or statutory duty, if correction of such error would have a reasonable possibility of aiding in substantiating the claim. 38 C.F.R. § 20.802(a). Following correction of the error, the AOJ must readjudicate the issue. Pub. L. No. 115-55, § 2(d)(2); 38 C.F.R. § 3.2502. A claimant may choose to file a new appeal to the Board from such readjudication or request higher-level review or a supplemental claim with the AOJ. 1. Entitlement to a compensable rating for hypothyroidism status post partial thyroidectomy with hoarseness of voice On March 12, 2021, VA received a VA Form 21-526EZ initiating the current appeal period for the claim herein. Prior to the March 2021 VA Form 21-526EZ, this claim was last adjudicated by the AOJ in a June 2020 Statement of the Case (SOC), but the Veteran did not submit a timely VA Form 9 or anything that could be interpreted as a substantive appeal within 60 days. As such, the current appeal period begins on March 12, 2021. The Veteran generally contends that the manifestations of this disability warrant a higher rating throughout the appeal period. Disability evaluations are determined by the application of the VA Schedule for Rating Disabilities (Rating Schedule). 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Veteran's thyroidectomy residuals are currently rated at 0 percent under DC 7903 since June 26, 1991; he is also already separately service connected for an associated thyroidectomy scar. See June 2021 Codesheet; 38 C.F.R. § 4.119, DC 7903. Notably, in the April 2021 Rating Decision, the AOJ determined that the Veteran's hoarseness of voice was at least as likely as not related to his hypothyroidism and, because hoarseness was not specifically listed in the Rating Schedule for DC 7903, rated it by analogy to DC 6516 (for chronic laryngitis), assigning a noncompensable rating. Under DC 7903, a 100 percent (maximum schedular) rating is assigned for hypothyroidism manifesting 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]) for a period of six months after an examiner has determined the condition is stabilized. 38 C.F.R. § 4.119, DC 7903. Thereafter, the residual effects of hypothyroidism are rated under the appropriate DC(s) within the appropriate body system(s) (e.g., eye, digestive, and mental disorders). Id. For hypothyroidism without myxedema, a 30 percent rating is assigned for six months after initial diagnosis. Id. Thereafter, residuals of disease or medical treatment, to include eye conditions, are rated under the most appropriate DC(s) under the appropriate body system (e.g., eye, digestive, mental disorders). Id. Under DC 6516, a 10 percent rating is warranted for chronic laryngitis manifesting in hoarseness, with inflammation of cords or mucous membrane. 38 C.F.R. § 4.97, DC 6516. A 30 percent (maximum schedular) rating is warranted for chronic laryngitis manifesting in hoarseness, with thickening or nodules of cords, polyps, submucous infiltration, or pre-malignant changes on biopsy. Id. In the March 2021 VA Form 21-526EZ, the Veteran reported hoarseness of his voice secondary to the partial thyroidectomy. During the April 2021 VA thyroid and parathyroid examination, the Veteran reported: persistent hoarseness since the partial thyroidectomy; taking Synthroid since the partial thyroidectomy; and a left thyroid nodule found in a recent ultrasound. The examiner opined that the hoarseness was a manifestation of hypothyroidism (noting that current medical literature suggested that a disruption in the thyroid hormones can directly affect an individual's voice quality resulting in hoarseness) but did not indicate that there were other manifestations of hypothyroidism or residuals of the thyroidectomy. Further, the examiner opined that the left thyroid nodule was unrelated to the hypothyroidism. During the April 2021 VA sinusitis/rhinitis and other conditions of the nose, throat, larynx, and pharynx examination, the Veteran reported: off and on hoarseness of his voice since the partial thyroidectomy; that the hoarseness had worsened over the last year or so; that his private provider recently found a suspicious nodule on his left thyroid; and current symptoms of intermittent pain occasionally and hoarseness of voice. The examiner opined that the hoarseness was related to the thyroid issues. On August 5, 2021, (within the 90-day evidence submission window) VA received a thyroid and parathyroid disability benefits questionnaire (DBQ) completed by the Veteran's regular, private provider Dr. BP, who documented: hypothyroidism status post right thyroidectomy; required medication supplementation; cardiovascular symptoms attributable to the hypothyroidism (although she did not specify the attributable symptoms and did not complete a concurrent heart conditions DBQ); an abnormal neck, described as enlarged left thyroid gland; abnormal reflexes (absent in the bilateral knees; hypoactive in the bilateral ankles; and hypoactive in the bilateral brachioradialis); a benign calcified nodule on the left thyroid gland that is under observation and being monitored for any changes; and functional impact of fatigue, cold/heat intolerance, and neuropathy and numbness. Based on the pertinent evidence of record, the Board finds that: (a) a compensable rating under DC 7903 is not warranted; and (b) a 10 percent rating, but no higher, under DC 6516 is warranted. Regarding DC 7903, the Board highlights that: (a) the April 2021 VA thyroid and parathyroid examiner did not identify myxedema (cold intolerance, muscular weakness, cardiovascular involvement, and mental disturbance) as a manifestation of the Veteran's hypothyroidism; (b) Dr. BP's August 2021 private DBQ noted manifestations of the Veteran's hypothyroidism to include cardiovascular symptoms, abnormal reflexes, fatigue, cold/heat intolerance, and neuropathy and numbness, but the Veteran is more than six months past the initial diagnosis and Dr. BP did not complete additional DBQ's to assess these manifestations on the appropriate body systems; and (c) the remaining VA and private medical evidence of record during the appeal period did not contain enough information to assess the manifestations identified by Dr. BP on the Veteran's appropriate body systems. The August 2021 private DBQ by Dr. BP is inadequate for failure to specify which cardiovascular symptoms might be secondary the hypothyroidism and for failure to provide enough detail to rate any associated abnormal reflexes, fatigue, cold/heat intolerance, and neuropathy and numbness; as such, Dr. BP's DBQ contains insufficient information to properly rate the Veteran's disability. This inadequacy does not allow for a remand because, as discussed above, the reasons for remand under the AMA are limited to: (a) correction of pre-decisional duty to assist errors; and (b) correction of an AOJ error in satisfying a regulatory or statutory duty, if correction of such error would have a reasonable possibility of aiding in substantiating the claim. 38 C.F.R. § 20.802(a). Thus, because the August 2021 private DBQ does not trigger a remand and because it does not contain adequate information to grant the claim under DC 7903, the Board must deny a compensable rating under DC 7903. However, if the Veteran so chooses, he may obtain additional evidence (for example, an addendum opinion or additional DBQ's from Dr. BP or another provider) and file a Supplemental Claim for any secondary conditions; if the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. 38 C.F.R. § 3.2501. Specific instructions for filing a Supplemental Claim are included with this decision. (Continued on the next page) Crucially, however, the Board finds that an increased rating of 10 percent, but no higher, is warranted under DC 6516. Regarding DC 6516, the Board highlights that: (a) although the pertinent evidence of record did not specifically document cord or mucus membrane inflammation in addition to hoarseness, the April 2021 VA sinusitis/rhinitis and other conditions of the nose, throat, larynx, and pharynx examiner documented intermittent pain in addition to hoarseness, which the Board finds to be more likely than not caused by irritated and inflamed cords; (b) the remaining VA and private medical evidence of record during the appeal period did not indicate that the hoarseness was accompanied by any of the other manifestations contemplated by a 30 percent rating (thickening or nodules of cords, polyps, submucous infiltration, or pre-malignant changes on biopsy). Although the VA examinations and the private DBQ noted a left thyroid nodule, a higher rating under DC 6516 requires the nodule to be on a vocal cord, which is not the case herein. Thus, the Board grants a 10 percent rating, but no higher, under DC 6516. Again, if the Veteran so chooses, he may obtain additional evidence to support his claim and file a Supplemental Claim for an increased rating above 10 percent; if the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. 38 C.F.R. § 3.2501. Specific instructions for filing a Supplemental Claim are included with this decision. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Daus, 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.