Citation Nr: 21077506 Decision Date: 12/30/21 Archive Date: 12/30/21 DOCKET NO. 18-15 804 DATE: December 30, 2021 ORDER Service connection for hypothyroidism is granted. REMANDED Service connection for a left leg disability (claimed as left leg bursitis), other than left leg exertional compartment syndrome, is remanded. Service connection for a right leg disability (claimed as right leg bursitis), other than right leg exertional compartment syndrome, is remanded. FINDING OF FACT The weight of the evidence is at least in relative equipoise as to whether the Veteran's hypothyroidism is related to his active service. CONCLUSION OF LAW The criteria for service connection for hypothyroidism have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from September 2005 to June 2009. For his meritorious service, the Veteran was awarded (among other decorations) the Navy and Marine Corps Achievement Medal. This matter is before the Board of Veterans' Appeal (Board) on appeal from rating decisions issued in August and November 2017 by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared at a hearing before the undersigned Veterans Law Judge in August 2021. A transcript of the hearing is in the Veteran's file. The Board notes that the Veteran's appeal originally included the issues of entitlement to service connection for right and left lower extremity shin splints. However, the January 2019 rating decision awarded service connection for the Veteran's right and left leg exertional chronic compartment syndrome and assigned a 10 percent disability evaluation, for each leg, effective February 14, 2017. A February 2019 rating decision increased the assigned ratings for bilateral leg exertional chronic compartment syndrome to 30 percent, respectively, effective February 14, 2017. As this represents a full grant of the benefit sought, that issue is no longer before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) (noting that a grant of service connection extinguishes appeals before the Board). Furthermore, the Veteran has not expressed disagreement with either the disability evaluation or effective date assigned. See 38 U.S.C. § 7105 (c) (2012); 38 C.F.R. §§ 3.104, 20.302, 20.1103. Service connection for hypothyroidism. The Veteran is seeking service connection for hypothyroidism. The Veteran contends that his hypothyroidism began in service and continued since that time. Service connection may be granted directly as a result of disease or injury incurred in service based on nexus using a three-element test: (1) The existence of a current 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). First, the Veteran's VA examinations and private treatment records clearly demonstrate that the Veteran has been diagnosed as suffering from hypothyroidism. See October 2017 VA examination. As to the second element for direct service connection, in-service incurrence or aggravation of a disease or injury, review of the Veteran's service treatment records revealed that the hypothyroidism was discovered at boot camp. As such, the Board finds that the second element of service connection has been met. The Veteran's claim of service connection for hypothyroidism has been denied on the erroneous basis that the Veteran's hypothyroidism pre-existed service and the objective evidence did not show evidence of worsening of the condition. However, the Board highlights that the condition was not noted at service entrance, as such the Veteran is found to be sound and fit for service. To support his claim, the Veteran submitted an opinion from L. A. Pierre, Jr., MD. Dr. Pierre opined that evidence indicates that the Veteran was diagnosed with hypothyroidism during his naval career. Moreover, Dr. Pierre opined that the Veteran did not present with any risk factors of hypothyroidism prior to entrance to service. Again, there are contrary opinions to the private examiner's conclusion. The Board refrains from summarizing them here, however, as in weighing these opinions, the evidence would be at least in equipoise. In such situations, benefit of the doubt must be afforded to the Veteran. Doing so here resolves the final element of the service connection framework in his favor. As such, the preponderance of the evidence is for finding that hypothyroidism was caused related to his active-duty service, and service connection is granted. See 38 C.F.R. § 3.303 (b); Walker, 708 F.3d at 1338. Thus, the claim for service connection is granted. REASONS FOR REMAND 1. Service connection for a left leg disability (claimed as left leg bursitis) is remanded. 2. Service connection for a right leg disability (claimed as right leg bursitis) is remanded. The Veteran is seeking service connection for bilateral leg bursitis. At his August 2021 hearing, the Veteran and his representative acknowledged the grant of service connection for bilateral exertional chronic compartment syndrome. Both expressed their concern that the grant of service connection for this issue may not cover all possible issues or diagnoses with the Veteran's bilateral legs. Accordingly, the Veteran's claim for service connection for bilateral leg bursitis has been recharacterized in an effort to ensure that all possible leg disabilities are considered. The Veteran contends that his bilateral leg bursitis is related to his active service, to include in-service complaints of leg, foot, and ankle pain. The record is conflicting as to whether the Veteran has a diagnosis of bilateral leg bursitis. The July 2017 VA examination report found a diagnosis of bilateral bursitis, but the October 2018 VA examination report did not find a diagnosis of bilateral bursitis. Moreover, the Veteran is also service connected for bilateral leg exertional chronic compartment syndrome. Upon remand, further medical guidance is needed to ascertain whether the Veteran's has diagnosis of bilateral leg bursitis, and if such diagnosis is separate and distinct from the Veteran's service-connected bilateral leg exertional chronic compartment syndrome. The matters are REMANDED for the following actions: Obtain an opinion as to whether the Veteran's bilateral leg bursitis (or any other bilateral leg disability other than exertional compartment syndrome) is related to his active service. Whether an examination is needed prior to rendering this opinion is left to the discretion of the examiner. Regardless of whether an examination is performed, the examiner is to state: (a) Whether the Veteran has confirmed diagnosis of bilateral leg bursitis (or any other disability of the bilateral legs other than compartment syndrome). If the VA examiner finds a diagnosis of bilateral leg bursitis, the VA examiner must address whether the diagnosis is separate and distinct from the Veteran's bilateral leg exertional chronic compartment syndrome. (b) If the VA examiner finds a separate and distinct of bilateral leg bursitis, the VA examiner should opine whether it is at least as likely as not that the Veteran's bilateral leg bursitis is related to his active service, to include in-service reports of leg, foot, and ankle complications. (Continued on next page) A complete rationale is required for all opinions offered by the reviewing examiner. Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J.R. Higgins 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.