Citation Nr: 21068056 Decision Date: 11/09/21 Archive Date: 11/09/21 DOCKET NO. 18-40 918 DATE: November 9, 2021 REMANDED Entitlement to service connection for a thyroid disorder, claimed as hypothyroid endocrine dysfunction, is remanded. REASONS FOR REMAND The Veteran had active service from November 1966 to September 1968, including service in the Republic of Vietnam. This matter was previously before the Board in July 2019 and in October 2020. The October 2020 decision denied service connection for hypothyroid endocrine dysfunction. The Veteran appealed to the United States Court of Appeals for Veterans Claims (Court), and a June 2021 Order granted a Joint Motion for Remand (JMR), vacating and remanding the Board's October 2020 decision. The Veteran asserts that his current thyroid disorder, claimed as hypothyroid endocrine dysfunction, is related to his in-service exposure to herbicide agents. As an initial matter, the Board notes that, effective January 1, 2021, the National Defense Authorization Act (NDAA) authorized the addition of three diseases to the list of those presumed to be related to in-service exposure to herbicide agents, including hypothyroidism. See 38 U.S.C. § 1116(a)(2)(K). However, in the instant case, the record reflects that the Veteran's hypothyroidism may have been caused by treatment with radioactive iodine for a thyroid nodule and hyperthyroidism in 1992. See December 2011 VA treatment note; see also a December 2016 DBQ from Dr. J.B. (noting that the Veteran has hypothyroid endocrine dysfunction that was a residual of treatment for a thyroid or parathyroid condition). Thus, there is evidence demonstrating that his current hypothyroidism may be due to an intercurrent cause. See 38 U.S.C. § 1113(a) (Where there is affirmative evidence to the contrary, or evidence to establish that an intercurrent injury or disease which is a recognized cause of any of the diseases or disabilities within the purview of section . . . 1116 . . . of this title, has been suffered between the date of separation from service and the onset of any such diseases or disabilities, . . . service-connection pursuant to section . . . 1116 . . . of this title . . . will not be in order). That stated, service connection for diseases not presumptively related to exposure to herbicide agents may still be demonstrated on a direct basis. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). In this case, a VA medical opinion was obtained in November 2019. Therein, an examiner opined that the Veteran's thyroid condition was less likely than not related to service. The rationale was that current medical evidence did not offer compelling evidence of causation or an associated risk relationship. However, as indicated by the parties to the JMR, because the examiner made a general reference to "current medical evidence," without citing to anything specific, and did not address the relevance of the Veteran's prior treatment for his thyroid nodule in 1992, the opinion is inadequate to decide the claim. Accordingly, another opinion is warranted. The matter is REMANDED for the following action: 1. Obtain a medical opinion addressing the etiology of the Veteran's thyroid disorder(s). The selected examiner should review the claims file, and then respond to the following: (a.) Identify any thyroid disorders that have been present since the date of claim, (i.e., since January 2017). (b.) For hypothyroidism in particular, please discuss whether such was either due to medical treatment for another thyroid disability, or was at least as likely as not a disease manifesting apart from such treatment. Please consider and discuss prior treatment records suggesting that the Veteran's hyperthyroid condition was a residual of radioactive iodine treatment for a thyroid nodule and hyperthyroidism. (c.) Is it at least as likely as not (approximately 50 percent probability) that any of the Veteran's current thyroid disorders had onset in, or are otherwise related to the Veteran's period of military service, to include his presumed exposure to herbicide agents? If the Veteran has current hypothyroidism that is a residual of treatment for a different primary thyroid condition, please opine as to whether that primary thyroid condition at least as likely as not had onset in, or was otherwise related to the Veteran's period of military service, to include his presumed exposure to herbicide agentseven if that primary condition has resolved. The examiner should consider and discuss the medical research submitted by the Veteran discussing a relationship between thyroid disorders and Agent Orange exposure, to include articles attached to a March 2018 request for assistance form his Congressman. A thorough medical rationale must accompany any opinion offered. If in the opinion of the examiner responses to the questions above cannot be provided without an in-person or virtual examination or interview, such should be scheduled. 2. Then, readjudicate the issue on appeal. V. Chiappetta Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Polly Johnson, 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.