Citation Nr: 21007598 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 17-00 117 DATE: February 10, 2021 REMANDED Entitlement to service connection for a thyroid condition, including hypothyroidism, claimed as related to exposure to ionizing radiation, is remanded. REASONS FOR REMAND The Veteran, who is the appellant in this case, served on active duty from October 1958 to October 1962 and from November 1962 to November 1988. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2014 decision of Department of Veterans Affairs (VA) Regional Office (RO). In September 2018, the Board remanded this appeal for additional development. Unfortunately, another remand is necessary. Entitlement to service connection for a thyroid condition, including hypothyroidism, claimed as related to exposure to ionizing radiation, is remanded. Once VA undertakes the effort to provide an examination when developing a claim, even if not statutorily obligated to do so, it must provide an adequate one. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). In a December 2020 VA medical opinion, the VA examiner opined that the Veteran’s thyroid condition, including hypothyroidism, was less likely than not incurred in or caused by exposure to ionizing radiation during service. The VA examiner correctly noted that the Veteran was exposed to ionizing radiation, but opined that such exposure is not significant enough to cause any permanent damage. Specifically, the VA examiner noted that the radiation levels inside the United States Capitol are 85 millirem (mrem)/year, which is close to the regulatory limit, and that the Veteran’s exposure was significantly lower than the one measured at the Capitol. However, the VA examiner appears to have misstated the evidence regarding the Veteran’s exposure. The November 2020 dose assessment from the Naval Dosimetry Center reported the dose in rem, while the VA examiner only discussed exposure in terms of millirem (one thousandth of a rem) and does not appear to have converted the dose between units. The Board notes that the November 2020 dose assessment from the Naval Dosimetry Center appears to indicate, after converting to millirem, that the Veteran’s exposure was greater than the radiation levels measured at the Capitol and referenced by the December 2020 VA medical opinion. For these reasons, the December 2020 VA medical opinion is inadequate, and remand is warranted to obtain an adequate etiology opinion for the Veteran’s claimed thyroid condition, including hypothyroidism. In addition, the Board in the August 2018 remand decision specifically directed the RO to obtain the requested etiology opinion from an endocrinologist. It is not clear from the record whether the December 2020 VA examiner is an endocrinologist. On remand, the VA examiner who renders the new etiology opinion should specifically indicate whether he or she is an endocrinologist. See Stegall v. West, 11 Vet. App. 268 (1998) (finding that a remand by the Board confers on the Veteran the right to compliance with its remand orders). The matters are REMANDED for the following action: 1. Obtain a new opinion from an endocrinologist as to the etiology of the Veteran’s hypothyroidism. The entire claims file, including a copy of this Remand, should be made available to, and be reviewed by, the examiner. An examination is not required. After reviewing the claims file, the endocrinologist is asked to provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s hypothyroidism is related to exposure to ionizing radiation during service. **The endocrinologist should note that the dose estimates provided the Naval Dosimetry Center in November 2020 are reported in rem, not millirem, and that conversion between such units may be required. As part of the opinion, the endocrinologist should specifically attest that his or her medical specialty is endocrinology. A thorough explanation must be provided for the opinion rendered. 2. Then, readjudicate the claim on appeal. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Thomas, 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.