Citation Nr: 21076443 Decision Date: 12/23/21 Archive Date: 12/23/21 DOCKET NO. 09-35 754 DATE: December 23, 2021 ORDER Service connection for a thyroid disorder is denied. FINDINGS OF FACT 1. The Veteran served on active duty from September 1961 to September 1964. 2. A thyroid disorder, diagnosed as enlarged thyroid (goiter), is a congenital defect that pre-existed service and was not subject to a superimposed disease or injury during service. CONCLUSION OF LAW A thyroid disorder was not incurred in service and a thyroid disorder was not shown during a period of active duty. 38 U.S.C. §§ 1110, 1116, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSION As a procedural matter, the claim for service connection for a thyroid disorder was previously remanded by the Board on several occasions for further development. The claim is now ready for adjudication. Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). In addition to the laws and regulations outlined above, a veteran is presumed to be in sound condition upon entrance into service, except for defects, infirmities or disorders noted when examined, accepted, and enrolled for service, or where evidence or medical judgment is such as to warrant a finding that the disease or injury existed before acceptance and enrollment. 38 U.S.C. § 1111. Only such conditions as are recorded in examination reports are to be considered as noted. 38 C.F.R. § 3.304 (b). If the disorder was not "noted" at the time of induction, VA must show by clear and unmistakable evidence both that the disease or injury existed prior to service and that the disease or injury was not aggravated by service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304; Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004); VAOPGCPREC 3-03 (July 16, 2003). Congenital or developmental "defects" automatically rebut the presumption of soundness because they are not "diseases" or "injuries" within the meaning of applicable legislation and are therefore considered to have pre-existed service. Defects are defined as "structural or inherent abnormalities or conditions which are more or less stationary in nature." VAOPGCPREC 82-90 (July 18, 1990). However, a congenital defect can still be subject to superimposed disease or injury. VAOPGCPREC 82-90. If such superimposed disease or injury does occur, service connection may be warranted for the resulting disability. On the other hand, if it is determined that a veteran has a congenital "disease," as opposed to a defect, it is not assumed that the disease must have preexisted service. Rather, the presumption of soundness still applies to congenital diseases that are not noted at entry. In cases where a veteran seeks service connection for a congenital condition, the Board must indicate whether the condition is a disease or defect and discuss the presumption of soundness, including obtaining a medical opinion if necessary. The Veteran contends that a thyroid disorder was due to exposure to toxins, to include drugs, gas, and other chemicals, during voluntary participation in medical experimentation during service. A current thyroid disorder, diagnosed as an enlarged thyroid (goiter), has been shown by the medical evidence. The record reflects that a thyroid disorder was not noted at service entry. Further, the service treatment records (STRs) do not document a thyroid disorder during service. In addition, the Veteran denied a history of goiter on the August 1964 separation examination. As such, a thyroid disorder was not noted at service entry and not noted during active duty. Rather, a May 1996 VA examiner noted an asymmetrical thyroid enlargement in the left neck area that had been present since childhood. In June 2020, a VA examiner opined that the Veteran's goiter was more likely than not a congenital condition; however, the examiner did not specify whether goiter was a congenital defect or a congenital disease. As to the issue of whether the thyroid enlargement was a congenital defect or a congenital disease, the same examiner clarified in June 2021 that the Veteran had a congenital defect. It was noted that there was no evidence that documented that thyroid enlargement clearly existed before service; however, the examiner explained that the two known etiologies of a thyroid goiter were thyroiditis or congenital. As the Veteran did not have thyroiditis, the examiner opined that the goiter was a congenital defect that was not palpated due to its small size which had a natural progression until it was discovered after separation from service. As such, this explained why a history of goiter may have been denied during the August 1964 service separation examination. As an enlarged thyroid has been characterized as a congenital defect, it is assumed that the disease must have preexisted service. As such, the presumption of soundness does not apply. Therefore, the question is whether the congenital defect was subject to a superimposed disease or injury during service that resulted in disability apart from the congenital or developmental defect. In June 2021, the VA examiner opined that the thyroid disorder was less likely than not subject to a superimposed disease or injury from toxins noted during service. Further, he opined that the thyroid goiter's growth was a natural progression and was not due to exposure to gases or drugs. He also indicated that the thyroid condition was not aggravated by service as there was no known nexus in the medical literature for a thyroid goiter that advanced decades after exposure to toxins such as drugs, gases, or chemicals. Accordingly, the medical evidence supports a finding that the thyroid disorder was a congenital defect and was not superimposed by any disease or injury during service. The medical evidence does not show any disease or injury to the thyroid during service that would result in additional disability. In this regard, the STRs do not show any thyroid symptoms or complaints during service. In addition, the Veteran has not identified, and the medical evidence does not demonstrate, any additional thyroid disability that resulted from any inservice disease or injury superimposed on his congenital defect. As goiter is a congenital defect that was not subject to a superimposed injury or disease during service, the medical evidence does not support service connection on this basis. The Board has considered the Veteran's lay statements that his disorder was caused by service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to the etiology of his current disorder due to the medical complexity of the matter involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Kokolas, 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.