Citation Nr: 21009691 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 15-16 390 DATE: February 23, 2021 ORDER Entitlement to service connection for a thyroid disability, to include residuals of Graves’ disease, and to include as due to exposure to herbicide agents, is denied. FINDING OF FACT A thyroid disability, claimed as residuals of Graves’ disease, was not shown in service, not shown to a compensable degree within one year from service, symptoms were not continuous since service, and a thyroid disability is not causally or etiologically related to service, nor is it related to conceded exposure to herbicide agents. CONCLUSION OF LAW The criteria for service connection for thyroid disability, to include residuals of Graves’ disease have not been met. 38 U.S.C. §§ 1110, 1131, 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 Army from June 1968 to January 1971 and in the United States Navy from October 1979 to November 1979. This matter was previously before the Board in July 2019, at which time it was remanded to the Department of Veterans Affairs (VA) Regional Office (RO) for further development. The RO most recently readjudicated the appeal in a September 2020 supplemental statement of the case. The Board finds that VA has substantially complied with the July 2019 Board remand. Entitlement to service connection for residuals of Grave's disease, to include as due to exposure to herbicide agents The Veteran asserts that his thyroid disability, to include residuals of Graves’ disease is related to service. More specifically, he asserts that thyroid disability, to include residuals of Graves’ disease may be related to in-service exposure to herbicide agents. 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). Service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Service connection may also be granted on a presumptive basis for diseases associated with herbicide exposure under 38 C.F.R. § 3.309 if a veteran: (1) served in the Republic of Vietnam between January 1962 and May 1975, (2) served between April 1968 and August 1971 in or near the Korean Demilitarized Zone; (3) served near the base perimeter of certain Thailand Air Force Bases during the Vietnam War era, or (4) regularly and repeatedly operated, maintained, or served aboard aircraft known to have been used to spray a herbicide agent during the Vietnam War Era. 38 C.F.R. § 3.307(a)(6). Notwithstanding the foregoing provisions regarding presumptive service connection for exposure to herbicide agents, a veteran is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). At the outset, the Board notes that the Veteran’s DD Form 214 indicates receipt of the Vietnam Service Medal and Vietnam Campaign Medal, and VA has already conceded Agent Orange exposure as the basis of presumptive service connection for coronary artery disease and diabetes mellitus. However, regulations pertaining to presumptive service connection based on exposure to an herbicide agent are not applicable to this appeal because thyroid disorders are not listed among the diseases for which the presumption applies. Therefore, the medical evidence does not support service connection based on presumptive herbicide agent exposure. 38 C.F.R. § 3.309. Nevertheless, as noted above, while service connection on a presumptive basis is not warranted, the Veteran is not precluded from establishing service connection with proof of actual direct causation. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). The record contains records from July 2011 in which the Veteran sent his private doctor a copy of a study showing an increased risk of Graves’ disease in people exposed to Agent Orange. The Veteran asked his doctor for an opinion about the etiology of his own diagnosis. The doctor responded that it “certainly is plausible” that Agent Orange exposure caused the Veteran’s Graves’ disease. Although the Veteran has argued that this should constitute a positive nexus opinion, the Board finds that the clinician’s vague language did not provide any estimate of the probability of a link between herbicide exposure and the Veteran’s specific case. It this regard, it is important for the Veteran to understand that no one would suggest that it is not possible that this disability is related to service. However, the question is not whether it is “certainly is plausible”, but if it is at least as likely as not (a 50% or greater chance) that this problem is relate to Agent Orange exposure. Following the July 2019 Board remand, the Veteran was afforded a VA examination for thyroid and parathyroid conditions in November 2019. The examiner noted a diagnosis of Grave’s Disease, resolved. The examiner noted that the condition’s onset was 2009-2010 and the condition has stayed the same since that time. The examiner also found the Veteran also had a diagnosis of metastatic papillary thyroid cancer with total thyroidectomy and prophylactic parathyroidectomy with residual hypothyroidism and hypoparathyroidism. At the time of the examination, the Veteran did not have any findings, signs, or symptoms attributable to a thyroid condition. The examiner opined that it was less likely than not that a thyroid disability was incurred in or caused by his service. The examiner noted that they observed no objective evidence of Graves as the Veteran has undergone a total thyroidectomy in 2011. The examiner also found that there is insufficient medical evidence, to include the article provided by the Veteran, to demonstrate a pathophysiological link between herbicide agent exposure and Graves’ disease or development of papillary thyroid cancer. The Board finds the November 2019 VA examiner opinion’s to be adequate and of great probative value. Hayes v. Brown, 9 Vet. App. 67 (1996). Significantly, there is no probative competent medical opinion of record to the contrary. The Board has considered the Veteran’s lay statements that his disorder was caused by service, and more specifically exposure to herbicide agents. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, thyroid disability, to include residuals of Graves’ disease, falls outside the realm of common knowledge of a lay person. To the extent that the Veteran believes that his thyroid disability, to include residuals of Graves’ disease, due to service or exposure to herbicide agents, as a lay person, he has not been shown to possess any specialized training in the medical field. His opinion as to the etiology of the claimed disorders is not competent evidence, as the nexus question involved in this case requires medical expertise. Here, the Board attaches greater probative weight to the clinical findings than to his statement. 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. John J. Crowley Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board V. Woehlke 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.