Citation Nr: 21066588 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 19-27 580 DATE: November 1, 2021 REMANDED Entitlement to service connection for a thyroid disability, to include hyperthyroidism, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from August 2007 to February 2008, with additional periods of active duty for training service (ACDUTRA) and inactive duty for training service (INACDUTRA) in the United States Army Reserve (Reserve). This matter initially came before the Board of Veterans' Appeals (Board) on appeal from a July 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). An April 2020 Board decision denied the Veteran's claim. The Veteran appeal that decision to the United States Court of Appeals for Veterans Claims (Court). The Court granted a March 2021 Joint Motion for Remand (JMR), vacating and remanding the issue to the Board. In July 2021, the Board remanded the appeal for additional development. The matter has now been returned to the Board for adjudication. Entitlement to service connection for a thyroid disability, to include hyperthyroidism, is remanded. The Veteran seeks service connection for a thyroid disability, to include hyperthyroidism or Grave's disease, which she contends had its onset during her active military service from August 2007 to February 2008. See Lay/Witness Statement (June 2021). In a June 2021 statement, the Veteran reported that beginning in late 2007, she experienced symptoms including tachycardia, shortness of breath, amenorrhea, weight loss, sensitivity to heat, weakness, dizziness, and shaking hands, which she now believes are related to her current hyperthyroidism. The Veteran's spouse, J.S., reported in a June 2021 statement that he knew the Veteran in high school prior to her enlistment and that she was in good health and led a very active lifestyle, including participation in sports, Reserve Officers' Training Corps (ROTC), and frequent outdoor activities. However, after she joined the military, in her letters and phone calls, she began reporting health problems. J.S. also observed that, when he visited her, he noticed that her hands shook, she was sweating heavily, and her neck appeared swollen. The Veteran was noted to be in good health at the time of her enlistment, with no thyroid condition noted on her entrance physical. See Report of Medical Examination (January 2007). The Veteran's service treatment records are silent for any diagnosis of hyperthyroidism during her period of active service- she was not diagnosed until August 2011; however, service treatment records for this period document complaints of dizziness, lightheadedness, and nausea after running; difficulty breathing attributed to panic attacks; fatigue; and mood lability/mood fluctuations, with the Veteran expressing concern that she had bipolar disorder. The Veteran's January 2012 Physical Evaluation Board Proceedings attributed her symptoms of shortness of breath and mood swings to the Veteran's diagnosis of hyperthyroidism. The Veteran has not been afforded a VA medical examination or opinion to address her contention that the symptoms she reported during her period of active duty service from August 2007 to February 2008 reflect the earliest manifestation of later diagnosed hyperthyroidism and that this condition was incurred during her active duty service. Accordingly, a remand is necessary to afford the Veteran a VA examination. See 38 C.F.R. § 3.159(c)(4). See also McLendon v. Nicholson, 20 Vet. App. 79 (2006) (a VA examination and/or opinion is warranted when there is an indication in the record that a current disability is related to military service; the threshold for an indication is low). In remanding this matter, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any thyroid disability. The entire claims file, to include a copy of this REMAND, should be made available to and reviewed by the clinician. Based on examination and review of the record, detail the Veteran's reported symptoms, including the nature, onset, progression and severity of any symptoms consistent with any thyroid disorder. The opinion should also identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). The clinician must opine on: (a) Whether any thyroid disability at least as likely as not (1) began during active service or (2) is related to an in-service injury, event, or disease. Explain. (b) Consider and expressly address the Veteran's theory that her thyroid disorder symptoms were first manifested during her active military service, and these included symptoms of amenorrhea, weight loss, sensitivity to heat, weakness, dizziness, mood swings, fatigue, and shaking hands. (c) Consider and expressly address the symptoms reportedly observed by J.S., shaking hands, heavy sweating, and swollen neck. NOTE (1): A negative medical opinion may not be predicated solely on the absence of in-service documented complaints, findings, or treatment. NOTE (2): The medical opinion may not ignore or dismiss the lay evidenceto include the competent report of in-service symptoms, which she believes were early symptoms of thyroid disorder, without providing an explanation. For example, if the Veteran's reports about her symptoms do not align with how the currently diagnosed disability is known to develop, explain; or if the Veteran's reports are generally inconsistent with medical knowledge or implausible, explain. NOTE (3): The Board makes no finding as to the credibility of the lay evidence and assertions at this time pending the medical opinion. 2. Ensure that the medical opinion obtained includes a complete rationale for the conclusions reached. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. C.A. SKOW Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E.D. Anderson, 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.