Citation Nr: 21067457
Decision Date: 11/04/21	Archive Date: 11/04/21

DOCKET NO. 17-00 117
DATE: November 4, 2021

ISSUE

Entitlement to service connection for a thyroid condition, including hyperthyroidism, claimed as related to exposure to ionizing radiation.

ORDER

Entitlement to service connection for a thyroid condition, including hyperthyroidism, claimed as related to exposure to ionizing radiation is denied.

FINDINGS OF FACT

1. The Veteran was exposed to ionizing radiation while stationed at McMurdo Station, Antarctica, during his active-duty service.

2. The Veteran has a current diagnosis of hyperthyroidism which is not a presumptive condition based on ionizing radiation exposure. 

3. The Veteran's current hyperthyroidism was not manifested during active military service or within one year thereafter, and is not shown to be casually or etiologically related to active military service or ionizing radiation exposure. 

CONCLUSION OF LAW

The criteria for entitlement to service connection for a thyroid condition, including hyperthyroidism, claimed as related to exposure to ionizing radiation have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.311.

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Veteran served on active duty in the United States Navy from October 1958 to October 1962 and from November 1962 to November 1988.  

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2014 decision of Department of Veterans Affairs (VA) Regional Office (RO). 

The Board remanded this issue September 2018 and February 2021 for further development. The appeal has returned to the Board for further appellate review. 

Upon review of the Veteran's claim file, the Board finds that there has been substantial compliance with the Board's remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998); Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). Therefore, the Board will proceed to the merits of the issue on appeal.

As the Veteran is unrepresented in this case, VA has a duty to construe his claims liberally. See Moody v. Principi, 360 F.3d 1306, 1310 (Fed. Cir. 2004); Szemraj v. Principi, 357 F.3d 1370, 1373 (Fed. Cir. 2004).

Please note that the case has been advanced on the docket pursuant to 38 C.F.R. § 20.900 (c).

Legal Criteria for Service Connection 

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish entitlement to service-connected compensation benefits, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service-the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). 

Service connection may also be granted for disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). 

Service connection may also be established for a current disability on the basis of a presumption that certain chronic diseases, to include endocrinopathies, manifesting themselves to a certain degree within a certain time after service must have had their onset in service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309(a). For endocrinopathies, the disease must have manifested to a degree of 10 percent or more within one year of service. 38 C.F.R. § 3.307(a)(3). 

VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). 

Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). However, the lack of contemporaneous medical evidence can be considered and weighed against a Veteran's lay statements. Id. Further, a negative inference may be drawn from the absence of complaints or treatment for an extended period. Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). 

After the evidence is assembled, it is the Board's responsibility to evaluate the entire record. See 38 U.S.C. § 7104(a). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. 

In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims (Court) stated that "a veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail." To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54.

Service Connection Based on the Presumption of Ionizing Radiation Exposure 

Service connection for conditions claimed to be due to exposure to ionizing radiation in service can be established in any of three different ways. See Davis v. Brown, 10 Vet. App. 209, 211 (1997); Rucker v. Brown, 10 Vet. App. 67, 71 (1997). First, there are diseases that are presumptively service-connected in radiation-exposed veterans under 38 U.S.C. § 1112 (c) and 38 C.F.R. § 3.309 (d). Second, service connection can be established under 38 C.F.R. § 3.303 (d) with the assistance of the procedural advantages prescribed in 38 C.F.R. § 3.311, if the condition at issue is a radiogenic disease. Third, direct service connection can be established under 38 C.F.R. § 3.303 (d) by showing that the disease was incurred during or aggravated by service without regard to the statutory presumptions. See Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994).

Under Combee, VA must not only determine whether a veteran had a disability recognized by VA as being etiologically related to exposure to ionizing radiation, but must also determine whether the disability was otherwise the result of active service. In other words, the fact that the requirements of a presumptive regulation are not met does not in and of itself preclude a claimant from establishing service connection by way of proof of actual direct causation.

A "radiation-exposed veteran" is defined by 38 C.F.R. § 3.309 (d)(3) as a veteran who while serving on active duty or on active duty for training or inactive duty training, participated in a radiation-risk activity. "Radiation-risk activity" is defined to mean onsite participation in a test involving the atmospheric detonation of a nuclear device; the occupation of Hiroshima, Japan or Nagasaki, Japan by United States forces during the period beginning on August 6, 1945, and ending on July 1, 1946; or internment as a prisoner of war (or service on active duty in Japan immediately following such internment) during World War II which resulted in an opportunity for exposure to ionizing radiation comparable to that of the United States occupational forces in Hiroshima or Nagasaki during the period from August 6, 1945 through July 1, 1946. 38 C.F.R. § 3.309 (b)(i), (ii).

Diseases presumptively service-connected for radiation-exposed veterans under the provisions of 38 U.S.C. § 1112 (c) and 38 C.F.R. § 3.309 (d)(2) are: leukemia (other than chronic lymphocytic leukemia), cancer of the thyroid, cancer of the breast, cancer of the pharynx, cancer of the esophagus, cancer of the stomach, cancer of the small intestine, cancer of the pancreas, multiple myeloma, lymphomas (except Hodgkin's disease), cancer of the bile ducts, cancer of the gall bladder, primary liver cancer (except if cirrhosis or hepatitis B is indicated), cancer of the salivary glands, cancer of the urinary tract; bronchiolo-alveolar carcinoma; cancer of the bone; cancer of the brain; cancer of the colon; cancer of the lung; and cancer of the ovary. 38 U.S.C. § 1112 (c)(2); 38 C.F.R. § 3.309 (d).

If a claimant does not qualify as a "radiation-exposed veteran" under 38 C.F.R. § 3.309 (d)(3) and/or does not suffer from one the presumptive conditions listed in 38 C.F.R. § 3.309 (d)(2), the veteran may still benefit from the special development procedures provided in 38 C.F.R. § 3.311 if the veteran suffers from a radiogenic disease and claims exposure to ionizing radiation in service. Under 38 C.F.R. § 3.311, "radiogenic disease" means a disease that may be induced by ionizing radiation. See 38 C.F.R. § 3.311 (b)(2) (2013).

Under 38 C.F.R. § 3.311, radiogenic disease means a disease that may be induced by ionizing radiation, and include the following: (i) All forms of leukemia, except chronic lymphatic (lymphocytic) leukemia; (ii) Thyroid cancer; (iii) Breast cancer; (iv) Lung cancer; (v) Bone cancer; (vi) Liver cancer; (vii) Skin cancer; (viii) Esophageal cancer; (ix) Stomach cancer; (x) Colon cancer; (xi) Pancreatic cancer; (xii) Kidney cancer; (xiii) Urinary bladder cancer; (xiv) Salivary gland cancer; (xv) Multiple myeloma; (xvi) Posterior subcapsular cataracts; (xvii) Non-malignant thyroid nodular disease; (xviii) Ovarian cancer; (xix) Parathyroid adenoma; (xx) Tumors of the brain and central nervous system; (xxi) Cancer of the rectum; (xxii) Lymphomas other than Hodgkin's disease; (xxiii) Prostate cancer; and (xxiv) Any other cancer. 38 C.F.R. § 3.311(b)(2). Again, acute pneumonia, COPD, and chronic kidney disease are not among the radiogenic diseases listed in 38 C.F.R. § 3.311(b)(2).

Under the special development procedures in § 3.311(a), dose data will be requested from the Department of Defense in claims based upon participation in atmospheric nuclear testing, and claims based upon participation in the American occupation of Hiroshima or Nagasaki, Japan, prior to July 1, 1946. 38 C.F.R. § 3.311 (a)(2) (2012). In all other claims, 38 C.F.R. § 3.311 (a) requires that a request be made for any available records concerning the veteran's exposure to radiation. These records normally include but may not be limited to the veteran's Record of Occupational Exposure to Ionizing Radiation (DD Form 1141), if maintained, service medical records, and other records which may contain information pertaining to the veteran's radiation dose in service. All such records will be forwarded to the Under Secretary for Health, who will be responsible for preparation of a dose estimate, to the extent feasible, based on available methodologies. 38 C.F.R. § 3.311 (a)(2)(iii) (2013).

Entitlement to service connection for a thyroid condition, including hyperthyroidism, claimed as related to exposure to ionizing radiation. 

The Veteran contends that he is entitled to service connection for his current thyroid condition because it was caused by exposure to ionizing radiation during service. 

Specifically, in an August 2012 Statement in Support of his claim, the Veteran reported that he was stationed at McMurdo Station, Antarctica, between September 1964 and October 1965. He stated that at that time there were 438 documented malfunctions at the nuclear power plant and 123 reports of radiation exposures.  Because the Veteran had been part of the plant construction crew, he reported that he was called upon to assist the plant maintenance crew with troubleshooting various facilities problems and he was not issued a dosimeter badge.  The Veteran also stated that the Station's water supply was provided by melting snow. 

For the reasons explained below, the Board finds that service connection for a thyroid condition is not warranted on a direct basis and there is no path for service connection via a presumed basis. 

Presumptive Service Connection

As an initial matter, the Board notes that the Veteran's military personal records reflect that he was stationed in McMurdo Station, Antarctica from February 1962 to March 1962 and from September 1964 to October 1965. Furthermore, personnel records reflect that the Veteran has been awarded the Antarctica Service Medal with Bronze Wintered Over Device. As such, VA concedes that the Veteran was exposed to radiation and is thus a "radiation-exposed veteran" within the meaning of 38 C.F.R. § 3.309(d)(1).

With regards to the Veteran's thyroid condition, the Board recognizes that thyroid cancer is listed under 38 C.F.R. § 3.309 (d)(2) as a disease presumptively linked to radiation exposure.  The record reflects that the Veteran was first diagnosed hypothyroidism in March 2013. The record does not contain any evidence that the Veteran has ever been diagnosed with thyroid cancer at any point during the appeal period. Since there is no competent evidence that the Veteran has been diagnosed a qualifying disease referred to in 38 C.F.R. § 3.309 (d)(2), service connection is not warranted for his claimed thyroid disability on this basis. 

Another path to presumptively establish service connection for a "radiogenic disease" based on exposure to ionizing radiation during service is via 38 C.F.R. § 3.311. That section provides that in all claims in which it is established that a radiogenic disease first became manifest after service and was not manifest to a compensable degree within any applicable presumptive period as specified in 38 C.F.R. § 3.307 or § 3.309, and it is contended that the disease is a result of exposure to ionizing radiation during service, an assessment will be made as to the size and nature of the radiation dose or doses. 38 C.F.R. § 3.311 (a)(1).

As explained above, the Veteran has attributed his thyroid disability to ionizing radiation exposure during service. However, as it has been noted, the competent evidence of record shows that the Veteran has been diagnosed with hypothyroidism, but not thyroid cancer or non-malignant thyroid nodular disease, which are considered "radiogenic diseases" under 38 C.F.R. § 3.311 (b)(2). Notably, under 38 C.F.R. § 3.311 (b)(4), other claimed diseases may be considered radiogenic if the appellant has cited or submitted competent scientific or medical evidence that supports that finding, that is not the case here. In this case, the Veteran has not submitted any such evidence indicating that hypothyroidism is considered a radiogenic disease. Because the Veteran has not been shown to have a "radiogenic disease" of the thyroid, the provisions regarding ionizing radiation exposure outlined in 38 C.F.R. § 3.311 are not for application with respect to his thyroid disability.

Lastly, turning to the presumption in favor of chronic diseases and continuity of symptomatology, hypothyroidism (endocrinopathies), is recognized as a chronic disease for VA purposes. 38 C.F.R. § 3.309(a). Here, though, the medical evidence does not show that the Veteran's hypothyroidism manifested in service or within one year of his separation from service. See 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Examination of all of the service medical records, post-service military records, or private records do not record any manifestation of any hypothyroidism or symptoms until March 2013. As such, service connection based on the presumption in favor of chronic diseases or continuity of symptomatology for hypothyroidism is not warranted in this case. Walker, 708 F.3d 1331; 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a).

Direct Service Connection 

As noted previously, where the evidence does not warrant presumptive service connection, a veteran is not precluded from establishing service connection for disability due to exposure to ionizing radiation with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1041 (Fed. Cir. 1994). In other words, a presumption of service connection provided by law is not the sole method for showing causation in establishing a claim for service connection for disability due to ionizing radiation.

Here, the Veteran's service treatment records are silent for any complaints, treatment or diagnosis of a thyroid disability during active service. Notably, the August 1988 retirement examination is silent for mention or complaints of problems with the Veteran's endocrine system. 

The Veteran's VA treatment records reflect that at a March 2013 medical examination the Veteran reported feeling weak and at that time the examiner noted that the Veteran was most likely experiencing symptomatic hyperthyroidism. The Veteran was prescribed a low dose Synthroid. A January 2014 treatment note confirmed the Veteran's diagnosis of hyperthyroidism.  

At the request of the VA, in an August 2020 letter, the Naval Dosimetry Center issued a finding regarding the Veteran's radiation exposure while in service. The finding revealed that the Veteran's radiation exposure did not exceed 00.240 rem Committed Dose Equivalent Thyroid (CDE-Thyroid), 00.862 rem Shallow Dose Equivalent (SDE), 00.568 rem Deep Dose Equivalent-Photon (DDE) and 00.110 rem Committed Effective Dose Equivalent (CEDE), as defined in 10 C.F.R. § 20. These values were derived from information provided by the Veteran in the McMurdo Station Radiation Dose Assessment Questionnaire (Radiation Questionnaire), which were incorporated into a dose assessment performed in accordance with the Defense Threat Reductions Agency Report, DTRA-TR-12-003 "Upper Bound Radiation Dose Assessment for Military Personnel at McMurdo station, Antarctica between 1962 and 1979."

A VA medical opinion was completed in December 2020. At that time the examiner opined that it was less likely than not that the Veteran's hyperthyroidism was related to his military service, including exposure to ionizing radiation. In providing a rationale the examiner explained that per medical literature, every day, everyone is exposed to low levels of ionizing radiation and this exposure can either be natural or manmade. The examiner went on to state that the International Commission on Radiological Protection (ICRP) recommends that the artificial irradiation of the public should be limited to an average of 100 mrem (1 mSv) of the effective dose each year, excluding medical and occupational exposure. For reference, the examiner pointed out that the radiation levels inside the United States Capital are 85 mrem per year (0.85 mSv/yr), which is close to the regulatory limit. The examiner then went on to explain that the Veteran was exposed to significantly less ionizing radiation than the one measured at the Capital. Furthermore, the examiner stated that although studies have conceded the risk of autoimmune thyroid disease with exposure to occupational ionizing radiation, a review of the medical records in this case, particularly the lack of documentation of thyroid antibodies, make this etiology less likely. Finally, the examiner stated that some degree of hyperthyroidism is common in older people, affecting 3-8% of older men. 

In the February 2021 remand, the Board determined that when the December 2020 examiner opined that the Veteran's exposure to ionizing radiation levels was not significant enough to cause permanent damage, the examiner appeared to have been misstating the evidence regarding the Veteran's exposure. As the Board pointed out, the November 2020 dose assessment reported the dose exposure in rem and the VA examiner only discussed exposure in terms of millirem and did not appear to have converted the dose between units. The Board determined that the November 2020 dose assessment from the Naval Dosimetry Center appeared to indicate, after converting to millirem, that the Veteran's exposure was greater than the radiation levels measured at the Capitol, as referenced by the December 2020 VA medical opinion. Therefore, the Board found that the December 2020 medical opinion was inadequate and remanded for a new opinion on the etiology of the Veteran's hypothyroidism. Upon remand, the Board directed than an endocrinologist should render the new medical opinion. 

The Veteran was afforded a new VA examination and a medical opinion was completed in August 2021. The examiner, who was not an endocrinologist, opined that it was less likely than not that the Veteran's hyperthyroidism was related to his military service, including exposure to ionizing radiation. In providing a rationale the examiner stated that according to the United States Regulatory Commission, Americans on average receive a radiation dose of 0.62 rem each year, with half of this dose coming from natural background radiation. The examiner explained that the record shows the Veteran was exposed to 0.24 rem of radiation (240 millirem) which is lower than the average radiation exposure each year in the United States. While radiation exposures have been associated with thyroid nodules and thyroid cancers at high levels, the examiner stated that these exposures are not a common cause of hyperthyroidism. The causes of hyperthyroidism due to radiation, as explained by the examiner, are caused by very high levels of radiation used for treatment of cancers in the head and neck.  

As stated above, the examiner who completed the August 2021 medical opinion was not an endocrinologist, as specifically directed by the Board's February 2021 remand. A Board remand confers on claimants, as a matter of law, the right to substantial compliance with the remand orders. Stegall v. West, 11 Vet. App. 268, 271 (1998); D'Aries v. Peake, 22 Vet. App. 97 (2008). Accordingly, in August 2020 the RO determined that this examination was inadequate and requested a new VA opinion.   

In September 2021 a new VA medical opinion was completed by an endocrinologist. Upon review of the entire claims file, the examiner opined that it was less likely than not that the Veteran's hyperthyroidism was related to his military service, including exposure to ionizing radiation. In providing a rationale, the examiner first explained that the conversion of 0.240 rems must be converted to "Absorbed Radiation Dose" (GY) in order for him to evaluate the effect of hypothyroidism in the relevant medical literature. The examiner referred to a conversion page and after completing the conversion and verifying it he determined that REM 0.24 converts to 0.0024 GY. The examiner went on to explain that according to the medical literature the risk of hypothyroidism was dependent on absorbed radiation doses, and the incidence of hypothyroidism was 44% in patients who received greater than 30 GY, 27% in patients who received between 7.5 to 30 GY and 2% in those who received 0 GY for 20 years. The examiner stated that previously, hypothyroidism after external irradiation was not thought to develop below a 10-20 GY dose, it is now suggested by newer data that it may develop after a 10 GY threshold following external beam radiation therapy (EBRT). The examiner pointed out that even at a very high dose, the radiation exposure would not have been expected to have a 50 percent chance of causing hyperthyroidism. Therefore, the examiner concluded that after considering the reported rem exposure and the medical literature with conversion, the Veteran's radiation exposure was not great enough to have at least a 50 percent chance that it caused his hypothyroidism. 

The Board finds the opinion of the September 2021 VA examiner to be highly probative. The examiner's opinion considered the Veteran's contention, the claims file, which included VA's concession of ionizing radiation exposure, and clinical medical evidence before providing a negative opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (the probative value of a medical opinion is derived from a factually accurate, fully articulated, and soundly reasoned opinion). The examiner's negative etiological opinion was supported by a sufficiently clear and well-reasoned rationale and was consistent with the verifiable facts regarding the Veteran's contentions. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005). For example, the examiner explained that as the risk of hypothyroidism was dependent on absorbed radiation doses, the Veteran's dose exposure of 0.0024 GY was not high enough to be the likely cause of his thyroid disability. There is no evidence that the September 2021 VA examiner was not competent or credible, and as the report was based on accurate facts and objective examinations, the Board finds that it is entitled to significant probative weight as to the etiology of the Veteran's thyroid disability. See Nieves-Rodriguez, Id.

The Board acknowledges that the Veteran is competent to provide statements as to his beliefs that his thyroid disability is related to service. Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007). In order for lay evidence to be competent, the individual must have personal knowledge, derived from his/her own senses, of what is being attested; "[c]ompetent testimony is thus limited to that which the witness has actually observed, and is within the realm of his personal knowledge." Layno v. Brown, 6 Vet. App. 465, 471 (1994). Here, the Veteran is competent to provide statements about his symptoms relating to his claimed thyroid disability. However, there is nothing in the record to suggest that the Veteran has the appropriate training, experience, or expertise to render a medical opinion regarding etiology of such a condition of any kind. See 38C.F.R. §3.159 (a)(1) (setting forth that competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). While the Veteran is competent to report what he has experienced, he is not competent to ascertain the etiology of any current condition, as the causative factors for such are not readily subject to lay observation. See Layno v. Brown, 6 Vet. App. 465 (1994); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Accordingly, his assertions to that effect are of no probative value.

In addition, the Board finds that the gap in time between the Veteran's last date of active service, in November 1988, to his initial evaluation by any medical provider regarding his thyroid in March 2013 to be probative of a lack of nexus between the diagnosed current disability and active service. A negative inference may be drawn from the absence of complaints or treatment for an extended period. See Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000).

Upon review of the record, the Board concludes that entitlement to service connection for a thyroid disability, to include hyperthyroidism, is not warranted. The Board notes a current diagnosis of hyperthyroidism, and thus the requirement for a current disability is shown. The Board acknowledges the Veteran's contentions, and the Veteran's post-service statements are noted. However, the record documents normal examination findings at his retirement examination in August 1988 and is silent for any mention of a thyroid disability until March 2013, when the Veteran was first diagnosed symptomatic hypothyroidism. There is no competent evidence to tie the current assertion to any in-service disease or injury. The Board thus finds the Veteran fails the third prong of the test for entitlement to service connection. See Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38C.F.R. §3.303.

In summary, the medical evidence in this case outweighs the Veteran's assertions that his current thyroid disability is of service origin. For these reasons, the preponderance of the evidence is against the claim and service connection for a thyroid condition, including hyperthyroidism is denied. As the preponderance of the evidence weighs against the claim, the benefit of the doubt rule is not for application. 38 U.S.C. § 5107(b), 38C.F.R. §4.3; see Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990).

 

Michael A. Pappas

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	T. Nettey, 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.