Citation Nr: 21074844 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 16-43 942 DATE: December 16, 2021 REMANDED Entitlement to service connection for hypothyroidism is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1980 to September 1992, November 2006 to November 2007, and September 2009 to November 2010. The matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the claim in November 2018 and June 2021 for further development by the RO. The case has been returned to the Board for further appellate action. Although further delay is regrettable, the Board finds that additional development is necessary prior to appellate review. Specifically, a remand is warranted in order to obtain an addendum medical opinion regarding the etiology of the Veteran's thyroid condition. The June 2021 Board remand directed the RO to obtain a medical opinion from an endocrinologist regarding the nature and etiology of the Veteran's thyroid condition, to include addressing whether the condition was due to environmental exposures or Anthrax vaccination, or whether his in-service heart palpitations were early manifestations of his degenerated colloid cyst. The examiner was also asked to opine on whether the condition represented an undiagnosed illness or medically unexplained chronic multi-symptom illness. Following remand, the RO obtained medical opinions from an endocrinologist in September 2021. The Board finds that the examiner adequately addressed the directives set out above. However, the June 2021 Board remand also directed the examiner to opine on whether the condition manifested within a year of the Veteran's separation from service on November 21, 2010. This information is necessary for the Board to make its decision, as endocrinopathies are chronic diseases subject to presumptive service connection, to include if they manifest within a year following separation from service pursuant to C.F.R. § 3.309(a). The matter is particularly relevant in this case, where the Veteran stated that he first reported his swollen thyroid to his family physician in February 2012 and his colloid cyst was removed in May 2012, or very shortly following a year after service. The September 2021 VA medical opinion is not adequate for adjudication with regards to this matter. The examiner stated that it was possible that the cyst was present but undetected long before the May 2012 surgery and that the etiology of the cyst and/or thyroid condition could be due to any of the following: Hashimoto's thyroiditis, an iodine deficiency or aggravation by the surgery. This response does not definitively clarify whether the Veteran's thyroid condition, as likely as not, constitutes an endocrinopathy for the purposes of C.F.R. § 3.309(a) and whether it manifested in the year following separation. The matter is REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Following completion of directive #1, obtain an addendum opinion from the VA examiner who provided the September 2021 medical opinion or an appropriate medical professional if the examiner is unavailable, so long as such examiner is also an endocrinologist. The claims file, as updated, must be made available to and reviewed by the examiner. The examiner is asked to opine on whether it is as least as likely as not (a 50 percent probability or greater) that the Veteran's thyroid condition constitutes an endocrinopathy that began during active service, manifested within one year after discharge from service, or was noted during service with continuity of the same symptomatology since service. A new examination of the Veteran is only necessary if deemed so by the examiner. A complete rationale should be given for all opinions and conclusions expressed. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and must state whether there is additional evidence that would permit the necessary opinion to be made. 3. Readjudicate the claim. D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Minaya, 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.