Citation Nr: 21076963 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 14-03 023 DATE: December 28, 2021 ORDER Entitlement to service connection for a bilateral hearing loss disability is denied. Entitlement to an evaluation in excess of 20 percent for lumbosacral disc bulge at L5-S1 is denied. Entitlement to an evaluation in excess of 30 percent for migraine headaches is denied. Entitlement to an evaluation in excess of 10 percent for hypothyroidism status post thyroidectomy (GOITER) is denied. FINDINGS OF FACT 1. The Veteran does not have a bilateral hearing loss disability in accordance with VA regulations. 2. Lumbosacral disc bulge at L5-S1 manifests in painful motion and limited motion with forward flexion less than 60 degrees. Forward flexion is greater than 30 degrees. There is no evidence of incapacitating episodes of IVDS consistent with regulation. There is no evidence of ankylosis. 3. Migraine headaches most closely approximate prostrating attacks occurring on average once a month over the last several months; and are not characterized by very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 4. Hypothyroidism status post thyroidectomy (GOITER) has been controlled with continuous medication. It has not manifested as myxedema or any other residual signs or symptoms as detailed in the rating criteria. CONCLUSIONS OF LAW 1. A bilateral hearing loss disability was not incurred in or aggravated by service and an organic disease of the nervous system may not be presumed to have been incurred therein. 38 U.S.C. §§ 1101, 1110, 1112, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.385. 2. The criteria for an evaluation in excess of 20 percent for lumbosacral disc bulge at L5-S1 have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5243. 3. The criteria for an evaluation in excess of 30 percent for migraine headaches have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.7, 4.124a, Diagnostic Code 8100. 4. The criteria for an evaluation in excess of 10 percent for hypothyroidism status post thyroidectomy (GOITER) have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.7, 4.119, Diagnostic Code 7903 (2016, 2021). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1985 to May 2006. These matters were previously remanded by the Board in February 2018 and April 2021 for evidentiary development. The Board has determined that the issue of entitlement to a TDIU has not been raised by the record in accordance with Rice. An examination report as recent as October 2021 indicates that the Veteran is still employed fulltime and has maintained this employment for a number of years. 1. Entitlement to service connection for a bilateral hearing loss disability Veterans are entitled to compensation if they develop a disability "resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty." 38 U.S.C. § 1110 (wartime service), 1131 (peacetime service). 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." Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service establishes that the disability was incurred in service. 38 C.F.R. § 3.303 (d). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). Sensorineural hearing loss is considered an organic disease of the nervous system, which is identified as a "chronic disease" under 38 U.S.C. § 1101 and 38 C.F.R. § 3.309 (a). The existence of a current disability is the cornerstone of a claim for VA disability compensation. See 38 U.S.C. §§ 1110, 1131; Degmetich v. Brown, 104 F. 3d 1328 (1997). "Congress specifically limits entitlement to service-connected disease or injury where such cases have resulted in a disability... in the absence of a proof of present disability there can be no claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Court has held that the requirement for service connection that a current disability be present is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim even though the disability resolves prior to the Secretary's adjudication of the claim. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). With respect to claims for service connection for hearing loss, the United States Court of Appeals for Veterans Claims (Court) has held that the threshold for normal hearing is from 0 to 20 decibels, and that higher threshold levels indicate some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). The Court further opined that 38 C.F.R. § 3.385, discussed below, then operates to establish when a hearing loss disability can be service connected. Id. at 159. For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The Veteran contends that she has a bilateral hearing loss disability due to noise exposure during service. The Veteran is competent to report in-service noise exposure and the Board finds such reports to be credible. The Veteran filed her compensation claim for a hearing loss disability in April 2012. Subsequent to her claim, she was afforded a VA audiological examination in September 2012. Objective testing at this examination did not indicate a hearing loss disability of either ear in accordance with 38 C.F.R. § 3.385. Pursuant to the assertion of the Veteran and her representative that the September 2012 VA examination did not accurately document her hearing loss, the Board ordered a new VA examination in its April 2021 Remand. At a May 2021 VA audiological examination, objective testing did not indicate a hearing loss disability of either ear in accordance with 38 C.F.R. § 3.385. These are the results of objective testing: HERTZ CNC 500 1000 2000 3000 4000 RIGHT 15 15 10 15 25 100% LEFT 15 20 15 15 20 100% There is no objective medical evidence of record documenting a bilateral hearing loss disability in accordance with 38 C.F.R. § 3.385 during the period on appeal (since April 2012). A review of the medical evidence does not reveal a hearing loss disability for either ear in accordance with 38 C.F.R. § 3.385. As a result, the Veteran does not have a hearing loss disability and has not had such a diagnosis or disability at any time during the claims period. McClain, supra. In the absence of a disability, compensation may not be awarded. The appellants assertion that she has a hearing loss disability is not credible and is not competent since the existence of disability is controlled by specific testing. In the absence of evidence of a current disability, there can be no grant of service connection under the law. See Brammer, supra. Rating 2. Entitlement to an evaluation in excess of 20 percent for lumbosacral disc bulge at L5-S1 Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule), found in 38 C.F.R., Part 4. The ratings are intended to compensate impairment in earning capacity due to a service-connected disease or injury. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Staged ratings are appropriate when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); see also Fenderson v. West, 12 Vet. App. 119 (1999). When assessing the severity of musculoskeletal disabilities that are at least partly rated on the basis of limitation of motion, VA must also consider the extent that the Veteran may have additional functional impairment above and beyond the limitation of motion objectively demonstrated, such as during times when his symptoms are most prevalent ("flare-ups") due to the extent of his pain (and painful motion), weakness, premature or excess fatigability, and incoordination-assuming these factors are not already contemplated by the governing rating criteria. DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995); see also 38 C.F.R. §§ 4.40, 4.45, 4.59. Nonetheless, even when the background factors listed in § 4.40 or § 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a (musculoskeletal system) or § 4.73 (muscle injury); a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016). VA examiners must attempt to elicit information from the record and the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups before determining that an estimate of motion loss in terms of degrees could not be given. Any inability to furnish such an estimate must be predicated on a lack of medical knowledge among the medical community at large, rather than insufficient knowledge by the individual examiner. Sharp v. Shulkin, 29 Vet. App. 26 (2017). The Veteran's lumbosacral disc bulge is evaluated under Diagnostic Code 5243 as 20 percent disabling, effective April 30, 2013, the date of her increased rating claim. As explained below, the current uniform 20 percent rating is appropriate for the entire period on appeal. See Hart, supra; Fenderson, supra. Disabilities of the spine are rated under either the General Formula for Diseases and Injuries of the Spine (General Formula) or the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher rating. While portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, Diagnostic Code 5243 and the General Formula for Diseases and Injuries of the Spine were not changed. The Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes was amended, but as explained below, there is no evidence of IVDS with incapacitating episodes consistent with regulation. Under the General Rating Formula, the current 20 percent evaluation is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or combined range of motion of the thoracolumbar spine not greater than 120 degrees; or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent evaluation is assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is assigned for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a. The rating criteria further explain under Note (1), that any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Notably, the Veteran is in receipt of service connection for radiculopathy of the sciatic and femoral nerves in both lower extremities. The evaluations of these disorders are not on appeal. The Formula for Rating Intervertebral Disc Syndrome Based specifies that an incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. As noted above, there is no evidence of record showing IVDS resulting in incapacitating episodes as defined by regulation. This rating formula will not be further discussed. At an August 2013 VA examination, forward flexion was 65 degrees. There was no objective evidence of painful motion. Repetitive-use testing was performed and did not result in additional limitation of motion. due to pain. Functional loss and/or impairment after repetitive use testing was due to less movement than normal and pain on movement. There were no neurologic abnormalities other than the already service-connected radiculopathy of the lower extremities. The Veteran reported flare-ups that sometimes made it "hard to go up and down stairs." There was no muscle spasm or guarding. There was no muscle atrophy or ankylosis. The examiner indicated that the Veteran did have IVDS but had not had any incapacitating episodes within the previous 12 months. At an April 2016 VA examination, forward flexion was 70 degrees. There was no pain noted on examination. Repetitive-use testing was performed and did not result in additional loss of function or range of motion. The examiner indicated that he was unable to determine whether pain, weakness, fatigability, or incoordination significantly limit functional ability with repeated use over time without resorting to mere speculation. The Veteran specifically denied flare-ups. There were no neurologic abnormalities other than the already service-connected radiculopathy of the lower extremities. There was no muscle spasm or guarding. There was not muscle atrophy, IVDS, or ankylosis. At an October 2018 VA examination, forward flexion was 70 degrees. There was pain on flexion upon examination, but it did not result in functional loss. Repetitive-use testing was performed and resulted in flexion of 65 degrees due to pain. Flexion was 60 degrees due to pain after repeated use over time. The Veteran reported flare-ups that could "be described as an intense dull pain triggered by prolonged sitting or standing." The examiner reported that pain caused functional loss during flare-ups and estimated flexion to be limited to 60 degrees during flare-ups. There were no neurologic abnormalities. There was no muscle spasm or guarding. There was not muscle atrophy or ankylosis. The examiner indicated that the Veteran did have IVDS but had not had any incapacitating episodes within the previous 12 months. At a June 2021 VA examination, forward flexion was 75 degrees. There was pain on flexion upon examination, resulting in functional loss. Passive range of motion was tested with flexion of 75 degrees. Repetitive-use testing was performed but did not result in additional loss of motion. Based on the Veteran's statements, the examiner estimated that flexion would be limited to 65 degrees after repeated use over time. The Veteran reported flare-ups twice a month or more that were moderate to severe. Flare-ups last a week or one to two days. Flare-ups were precipitated by sitting, walking for prolonged periods, and lifting heavy objects. The examiner reported that pain caused functional loss during flare-ups and estimated flexion to be limited to 65 degrees during flare-ups. There were no neurologic abnormalities. There was no muscle spasm or guarding. There was not muscle atrophy or ankylosis. The examiner indicated that the Veteran did not have IVDS. Upon careful review of the evidence of record, including contemporaneous VA treatment records, the Board has determined that an evaluation in excess of 20 percent is not warranted. A review of the medical and lay evidence indicates that the Veteran's lumbosacral disc disorder most closely approximates a 20 percent evaluation during this period. An evaluation in excess of 20 percent is not warranted as the evidence does not show functional limitation resulting in flexion of 30 degrees or less, incapacitating episodes consistent with regulation, or ankylosis. Rather, the evidence establishes that flexion is significantly greater than 30 degrees even when accounting for additional limitation due to pain, flare-ups, and repeated use. To the extent that the Veteran experienced pain during range of motion testing, was limited by pain, or there is functional loss during flare-ups, the Board has considered DeLuca and Sharp. The evidence is consistent with forward flexion significantly better than 30 degrees. In order to warrant a higher evaluation, there must be the functional equivalent of limitation of flexion to 30 degrees or ankylosis. 38 C.F.R. §§ 4.40, 4.45. The Board acknowledges the Veteran's complaints of pain and painful motion. We have also considered the functional impairment due to the Veteran's reported flare-ups. Even when considering functional loss due to pain and flare-ups, flexion is consistently greater than 30 degrees and there is clearly not functional impairment consistent with ankylosis. The Board has not overlooked the statements by the Veteran and her family with regard to the severity of her disability during this period. They are competent to report on factual matters of which they have firsthand knowledge, e.g., experiencing pain. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). However, in this instance, the objective medical evidence is simply more probative. The claim must be denied. 3. Entitlement to an evaluation in excess of 30 percent for migraine headaches The Veteran's migraine headaches are currently evaluated as 30 percent disabling under Diagnostic Code 8100. The Veteran filed her increased rating claim on December 18, 2013. As explained below, the Board has determined that the current uniform evaluation of 30 percent is warranted for the entire period on appeal. See Hart, supra; Fenderson, supra. Under Diagnostic Code 8100, the current 30 percent disability evaluation is assigned where there are characteristic prostrating attacks occurring on average once a month over the last several months. For the schedular maximum 50 percent disability evaluation to be warranted, there must be migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a, Diagnostic Code 8100. "Productive of severe economic adaptability" has not been clearly defined by regulations or by case law. The United States Court of Appeals for Veterans Claims (Court) has noted that "productive of" can either have the meaning of "producing" or "capable of producing." Pierce v. Principi, 18 Vet. App. 440, 445 (2004). Thus, headaches need not actually "produce" severe economic inadaptability to warrant the 50 percent rating. Id. at 445-46. Further, "economic inadaptability" does not mean unemployability, as such would undermine the purpose of regulations pertaining to TDIU. Id. at 446; see also 38 C.F.R. § 4.16. At a February 2014 VA examination, the Veteran reported that the frequency of headaches had increased to three to four per month lasting two to three days on average. She took Tylenol but no prophylactic medication. She reported taking off or leaving work early at least 10 days due to headaches. The examiner reported sharp headache pain in front of the head behind the eyes, sometimes in the back of the head. The Veteran experienced nausea and dizziness with the headaches. Typical duration was more than two days and typical location was the front of the head. She had characteristic prostrating attacks of migraine headache pain more frequently than once per month. She did not have very frequent prostrating and prolonged attacks of migraine headache pain or non-migraine headache pain. There was functional impact described as "moderately affect[ing] sedentary/physical employment." At a June 2021 VA examination, the Veteran reported taking BC powder (aspirin) to treat her headaches. Headache pain was described as constant head pain and on both sides of the head. The Veteran experienced nausea, sensitivity to light, and changes in vision with headaches. Typical duration was less than one day, and typical location of pain was both sides of the head. She had characteristic prostrating attacks of pain once every month. There were not very prostrating and prolonged attacks of migraine/non-migraine pain productive of severe economic inadaptability. After a review of the record, the Board finds that the current uniform 30 percent evaluation is warranted for the entire period on appeal. The Board acknowledges that the Veteran's headaches have at times affected her ability to work and notes her assertions in the February 2014 examination report that she missed all or part of ten workdays over the course of a year due to headaches. In addition, the Board notes her February 2021 statement and attached employment timesheets documenting sick leave. The six years' worth of timesheets document the use of sick leave, but even if it is assumed that every hour of sick leave was used due to the Veteran's migraines, it is does not seem to be an inordinate amount of sick leave used. The timesheets indicate that despite the use of some sick leave, the Veteran was able to steadily accumulate sick leave over the course of the six years documented. A review of the record indicates that she has continued employment as a supervisor at the Department of Veterans Affairs. Her continued employment does not by itself rule out the possibility of headaches producing or being capable of producing severe economic inadaptability. However, when considered with the Veteran's reports at her VA examinations, lay statements, and the clinical findings of the examiners, the weight of the evidence shows that functional impairment due to migraine headaches is more closely aligned with a 30 percent evaluation. A review of the medical and lay evidence of record indicates that the Veteran's migraine headaches more closely approximate the rating criteria for a 30 percent evaluation for the entire period on appeal. VA examinations do not indicate that the Veteran's migraine headaches have resulted in "severe economic inadaptability" at any point, and to the extent that the Veteran has submitted lay statements, while suggestive of some occupational impairment, they do not indicate that manifestations of migraine headaches amount to "severe economic inadaptability." Similarly, it is not evident that the migraines are capable of producing severe economic inadaptability at this time. Rather, the reported symptoms are consistent with a 30 percent evaluation. In reaching this finding, the Board acknowledges that the Veteran is competent to testify to lay observable symptomatology. Jandreau, supra. The Board has also reviewed the statements from the Veteran's family regarding the impact of her migraines. Their statements are entitled to probative value as to the severity of headaches. However, to the degree that they assert "severe economic inadaptability" consistent with a 50 percent evaluation, these statements are contradicted by the objective medical evidence and the Veteran's own timesheets. Based on the lay and medical evidence of record, the Board finds that the Veteran's headaches do not more nearly approximate the level of severity contemplated by a rating in excess of 30 percent at any point. The preponderance of the evidence is against the claim. It must be denied. 4. Entitlement to an evaluation in excess of 10 percent for hypothyroidism status post thyroidectomy (goiter) The Veteran's hypothyroidism status post thyroidectomy is currently evaluated as 10 percent disabling under Diagnostic Code 7903. She filed her increased rating claim on December 18, 2013. Diagnostic Code 7903 was amended on December 10, 2017. The Veteran's current 10 percent evaluation is based on the previous criteria. Under those criteria, a 10 percent evaluation was warranted for fatigability, or; continuous medication required for control. A 30 percent evaluation was warranted for fatigability, constipation, and mental sluggishness. A 60 percent evaluation was warranted for muscular weakness, mental disturbance, and weight gain. A 100 percent evaluation was warranted for cold intolerance, muscular weakness, cardiovascular involvement, mental disturbance (dementia, slowing of thought, depression), bradycardia (less than 60 beats per minute), and sleepiness. 38 C.F.R. § 4.119, Diagnostic Code 7903 (2016). Under the current version of Diagnostic Code 7903, a 30 percent rating is assigned for hypothyroidism without myxedema. Note (2) appending the 30 percent criteria states that this evaluation shall continue for six months after initial diagnosis. Thereafter, rate residuals of disease or medical treatment under the most appropriate diagnostic code(s) under the appropriate body system (e.g., eye, digestive, mental disorders). Note (3) states that if eye involvement, such as exophthalmos, corneal ulcer, blurred vision, or diplopia, is also present due to thyroid disease, also separately evaluate under the appropriate diagnostic code(s) in §4.79, Schedule of Ratings Eye (such as diplopia (DC 6090) or impairment of central visual acuity (DCs 6061-6066)). A 100 percent rating is assigned for hypothyroidism manifesting as myxedema (cold intolerance, muscular weakness, cardiovascular involvement (including, but not limited to hypotension, bradycardia, and pericardial effusion), and mental disturbance (including, but not limited to dementia, slowing of thought and depression)) for a period of six months after an examiner has determined the condition is stabilized. Note (1) appending the 100 percent criteria states that this evaluation shall continue for six months beyond the date that an examining physician has determined crisis stabilization. Thereafter, the residual effects of hypothyroidism shall be rated under the appropriate diagnostic code(s) within the appropriate body system(s) (e.g., eye, digestive, and mental disorders). 38 C.F.R. § 4.119, Diagnostic Code 7903. At a February 2014 VA examination, there was no residual endocrine dysfunction. There were no current findings, signs, or symptoms attributable to a hypothyroid condition or any other thyroid condition. Eyes and neck were normal. Pulse was regular. Reflexes were normal. There was no functional impact. At an October 2018 VA examination, it was reported that hypothyroidism and the residual endocrine dysfunction was managed with medication. There were no current findings, signs, or symptoms attributable to the thyroid disorder. Eyes and neck were normal. Pulse was regular. Reflexes were normal. There was functional impact as the Veteran reported that she believed her medication contributed to hypertension, dizziness, and mood changes. At a November 2019 VA examination, the Veteran reported worsening symptoms with good days and bad days. She did not believe her thyroid medication was always effective. The examiner noted that hypothyroidism was managed with medication. The examination report indicated that there were no current findings, signs, or symptoms attributable to a thyroid condition. Eyes and neck were normal. Pulse was regular. Reflexes were normal. There was functional impact as the Veteran reported that she believed her medication contributed to hypertension, dizziness, and mood changes. At a June 2021 VA examination, there was no reported residual endocrine dysfunction. The examination report indicated that there were no current findings, signs, or symptoms attributable to a thyroid condition. Eyes and neck were normal. Pulse was regular. Reflexes were all hypoactive. The Veteran reported fatigue, weight gain, cold intolerance, and heat intolerance. The examiner indicated that the Veteran's tiredness and weight gain are not necessarily related to hypothyroidism. There was no sign of mental disturbance, muscular weakness, cardiovascular involvement, or bradycardia. There was not myxedema. The examiner reported no functional impact. After a review of the medical and lay evidence, an evaluation in excess of 10 percent is not warranted. VA examinations during the period on appeal do not document findings consistent with an evaluation in excess of 10 percent under either the old or new rating criteria. The medical evidence does not indicate fatigability, constipation, and mental sluggishness due to hypothyroidism. To the extent that the Veteran's reported fatigue is due to hypothyroidism, there is no evidence of constipation and mental sluggishness as necessary for a 30 percent evaluation under the old criteria. Similarly, there is no indication of muscular weakness and mental disturbance due to hypothyroidism necessary for a 60 percent evaluation, even to the extent that weight gain may be related to the Veteran's disorder. As to the new criteria, the medical evidence does not show any current findings, signs, or symptoms attributable to the Veteran's hypothyroidism. An evaluation of 30 percent is not warranted. The criteria for a 30 percent disability rating for hypothyroidism without myxedema are not met, as a 30 percent disability rating under Diagnostic Code 7903 is only applicable for 6 months after initial diagnosis. Specific to an evaluation under Note (2) or Note (3), there is no evidence of eye, digestive, or mental symptoms or manifestations related to hypothyroidism. There is no evidence of myxedema as is necessary for a 100 percent evaluation. 38 C.F.R. § 4.119. The Board notes the Veteran's subjective reports of fatigue, weight gain, cold intolerance, and heat intolerance. She is competent to report these symptoms, but the medical evidence of record is more probative in this instance. Qualified medical professionals determined that the Veteran's subjective reports are not related to her thyroid disorder. The Veteran lacks the medical expertise to link her reported symptoms to hypothyroidism. The medical evidence indicates that her thyroid disorder is managed effectively by medication and is asymptomatic. The examination reports are not contradicted by any of the other evidence of record. The preponderance of the evidence is against an evaluation in excess of 10 percent for hypothyroidism under either the old or new rating criteria. Ultimately, the Board places the most probative weight on the results of the physical examinations by medical professionals which show no evidence of residuals of hypothyroidism to warrant higher or separate disability ratings. The preponderance of the evidence is against the claim. It must be denied. H. N. SCHWARTZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board W. R. Stephens, 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.