Citation Nr: 21072376 Decision Date: 12/03/21 Archive Date: 12/03/21 DOCKET NO. 08-15 052 DATE: December 3, 2021 ORDER Entitlement to service connection for a thyroid condition, diagnosed as multinodular goiter, is denied. REMANDED The issue of entitlement to service connection for a right hip disability, to include degenerative joint disease, is remanded. FINDING OF FACT The evidence does not show the Veteran's multinodular goiter began during her active service, or is otherwise related to an in-service event, injury, or disease. CONCLUSION OF LAW The criteria for entitlement to service connection for a thyroid condition, to include multinodular goiter have not been met. 38 U.S.C. §§ 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1978 to April 1981. These matters come before the Board of Veterans' Appeals (Board) on appeal of a December 2008 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously remanded by the Board in October 2018. A review of the claims file shows that there has been substantial compliance with the Board's remand directives related to the issue of entitlement to service connection for a thyroid condition. See Stegall v. West, 11 Vet. App. 268 (1998). The case has been returned to the Board for review. The Veteran testified at a Travel Board hearing before a Veterans Law Judge (VLJ) of the Board in April 2013. The law requires that the VLJ who conducts a hearing on an appeal must participate in any decision made on that appeal. 38 U.S.C. § 7107 (c) (2012); 38 C.F.R. § 20.707. However, the VLJ who conducted the April 2013 Board hearing is no longer employed by the Board. In June 2018, the Veteran and her representative were sent a letter notifying them that the VLJ who presided over the April 2013 hearing is no longer employed by the Board, and offering another hearing before a different VLJ. The letter notified the Veteran that she had 30 days from the date of letter to respond and that if no response was received the Board will assume the Veteran does not want another hearing and the Board will proceed accordingly. The Veteran did not respond to the letter. As such, the Board will consider the case on the evidence of record. Neither the Veteran nor her representative has raised any issues with regard to the duty to notify or duty to assist as they pertain to the issue denied in this decision. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). 1. Entitlement to service connection for a thyroid condition is denied. The Veteran seeks entitlement to service connection for multinodular goiter. She contends that her current multinodular goiter is related to her in-service swollen glands. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, although the Veteran was treated for swollen glands during her active service and was subsequently diagnosed with multinodular goiter, the preponderance of the evidence weighs against finding that the Veteran's multinodular goiter began during her active service or is otherwise related to an in-service injury, event, or disease. The medical treatment records show the Veteran was not diagnosed with multinodular goiter or any other thyroid condition until 2009, many years after her separation from service. Although the Veteran is competent to report having experienced symptoms of swollen glands during her active service, she is not considered competent to provide a diagnosis in this case, to determine that those symptoms were manifestations of a thyroid disability, or to attribute her post-service multinodular goiter to her in-service swollen glands. The issue is medically complex, as it requires knowledge of the development and progression of specific thyroid disabilities and the interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Therefore, to determine whether the Veteran's multinodular goiter first diagnosed years after her separation from active service had its onset during her active service or is related to an in-service injury, event, or disease, the Board turns to the competent medical evidence of record. The Veteran was provided a VA examination related to her thyroids in July 2021. The VA examiner examined the Veteran, interviewed the Veteran and conducted an in-person examination. The VA examiner diagnosed the Veteran with multinodular goiter and opined that the condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. As rationale, the VA examiner noted that the January 1981 service treatment record reflects swollen glands associated with colds. The VA examiner further explained that the January 1981 treatment record does not mention nodules/thyroid and that swollen glands are often associated with viral illness and that swollen glands does not refer to the thyroid nodules. The VA examiner noted that the Veteran's post service medical records do not reflect a history of nodules or thyroid issues until many years after her separation. The Board affords probative weight to the July 2021 VA examiner's opinion because it is consistent with the record, is supported by appropriate rationale and was provided based on the examiner's knowledge and expertise. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Prejean v. West, 13 Vet. App. 444 (2000). The examiner explained that the in-service swollen glands are related to viral illness and not a thyroid condition. The Board accepts the VA examiner's opinion as probative evidence that the Veteran's multinodular goiter did not have its onset during her active service and is not etiologically related to an in-service event, injury, or disease, to include the in-service symptoms documented in the service treatment records. In summary, the preponderance of the evidence is against finding that the Veteran's multinodular goiter began during her active service, or is otherwise related to an in-service event, injury, or disease. In view of the foregoing, the Board concludes that the preponderance of the evidence is against the claim for entitlement to service connection for a thyroid disability, to include multinodular goiter. Because the preponderance of the evidence is against the claim, the doctrine of reasonable doubt is not for application, and the claim must be denied. 38 U.S.C. § 5107 (b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. The issue of entitlement to service connection for a right hip disability is remanded. The October 2018 Board remand directed the AOJ to schedule the Veteran for an examination to determine the nature and etiology of any right hip disability. The remand specified that the opinion obtained should reflect consideration of the Veteran's in service right hip injury. The remand further directed that opinions be obtained as to whether the Veteran's current right hip disability is secondary to a service-connected disability. The Veteran was provided a VA opinion related to her right hip in May 2019. The VA examiner reviewed the record and opined that the Veteran's current right hip disability is less likely than not incurred in or caused by the claimed in-service injury, event, or illness. As rationale, the VA examiner explained that the Veteran's service treatment records do not reflect complaints or treatment of hip pain during her active service. The VA examiner further explained that the first mention of a right hip disability is nearly 25 years after her separation from active service and after onset of her back condition. However, a review of the Veteran's service treatment records reflect that the Veteran was treated for right hip and leg pain in August 1980, during her active service. As to whether the Veteran's current right hip disability is proximately due to or the result of the Veteran's service-connected conditions or aggravated beyond its natural progression by a service-connected disability the VA examiner merely copied the direct service connection opinion. Therefore, the opinions obtained, related to the Veteran's right hip disability, do not substantially complete the October 2018 Board remand directives and are not adequate for decision-making purposes. See 38 U.S.C. § 5103A (b); Stegall v. West, 11 Vet. App. 268, 271 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). Therefore, the issue must be remanded for another opinion. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Further, the Veteran has reported that she receives private treatment relating to her hip disability. On remand, the Veteran must be asked to complete authorization forms concerning any private medical treatment and/or submit copies of any relevant records. 38 U.S.C. § 5103A (c); 38 C.F.R. § 3.159 (c) (1). The matter is REMANDED for the following action: 1. Contact the Veteran and request that she complete and submit to VA a signed authorization for disclosure of medical records to VA for each private medical health care provider from whom she has received treatment for the disability at issue on appeal. After receiving any completed authorization form(s), undertake all appropriate efforts to attempt to obtain the identified records. All development efforts with respect to this directive should be associated with the claims file. The Veteran is encouraged to submit directly to VA any outstanding, relevant medical records in her possession. 2. Forward the record and a copy of this remand to the examiner who provided the May 2019 opinion, related to her right hip, or if the examiner is unavailable, another suitably qualified examiner, for completion of an addendum opinion. If the examiner determines that another in-person examination of the Veteran is required to provide the below-requested information, then such an examination should be scheduled. Following review of the record, the examiner should express an opinion as to: 3. Whether it is at least as likely as not (50 percent or greater probability) that any right hip disability is related to the Veteran's service, to include her in-service treatment for right hip pain. 4. If not, whether it is at least as likely as not (50 percent or greater probability) that the Veteran's right hip disability is proximately due to or the result of her service-connected disabilities. Rationale must be provided for the opinion proffered. 5. If not, whether it is at least as likely as not (50 percent or greater probability) that the Veteran's right hip disability is aggravated beyond natural progression by her service-connected disabilities. Rationale must be provided for the opinion proffered. MICHELLE L. KANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. G. LeMoine, 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.