Citation Nr: 21011041 Decision Date: 02/26/21 Archive Date: 02/26/21 DOCKET NO. 190328-18261 DATE: February 26, 2021 REMANDED Entitlement to service connection for thyroid cancer is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1954 to November 1958 and from May 1959 to June 1975. The Veteran’s service included a tour of duty in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2019 rating decision by the Department of Veterans Affairs (VA). In March 2019, the Veteran elected the Direct Review lane. In September 2019, the Board denied entitlement to service connection for thyroid cancer. Following the Board’s decision, the Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In October 2020, the Secretary of VA and a representative of the Veteran filed a Joint Motion for Remand (JMR). In this case, the Board acknowledged that the Veteran was exposed to Agent Orange and contaminated water at Camp Lejeune. The Veteran’s service treatment records were also silent for any treatment or diagnosis of a thyroid disorder while on active duty. In turn, the Board found that the Veteran should not be afforded a VA examination because there was no in-service event, illness, or injury to the Veteran’s thyroid during service, and there was no evidence of an indication that the current disability or current symptoms may be related to any alleged in-service event. Even though the Board found that thyroid cancer is not a presumed condition that has been associated with exposure to Agent Orange or contaminated water, and the Veteran was not treated for a thyroid disorder in service, the parties agreed that the Board did not adequately address why the Veteran should not be afforded a VA examination or opinion. In addition, the parties agreed that the Board erred when it did not discuss the National Academy of Sciences (NAS) Institute of Medicine’s Veterans and AO: Update 2014 (2014 Update) that concluded that there is “limited or suggestive evidence of an association” between hypothyroidism and herbicide. Although this evidence was not included in the original claim, and hypothyroidism is a separate and distinct disability, the parties agreed that the Board erred because it provided no analysis as to how the 2014 Update impacted Veteran’s claim. Lastly, the parties agreed that the Board erred when it did not acquire the Veteran’s private treatment records that were referenced in his VA treatment records, to include those from Dr. L. and Dr. D. 1. Entitlement to service connection for thyroid cancer is remanded. In the October 2020 JMR, the parties agreed that the Board failed to adequately address the impact of the Veteran’s in-service exposure to Agent Orange and contaminated water at Camp Lejeune on VA’s obligation to provide and examination or opinion in this matter. Moreover, the parties agreed that the Board failed to adequately address the National Academy of Sciences (NAS) Institute of Medicine’s Veterans and AO: Update 2014 (2014 Update) that concluded that there is “limited or suggestive evidence of an association” between hypothyroidism and herbicide. The parties also agreed that the Board erred when it did not seek to obtain private treatment records that were referenced in the Veteran’s VA treatment records, to include those from Dr. L. and Dr. D. Therefore, as a result of the JMR, the Board finds that a remand is required in order to make an effort to obtain the Veteran’s private medical record and an appropriate VA medical opinion, which includes consideration of the NAS article noted above, prior to the Board’s further review of the claim on appeal. The matters are REMANDED for the following action: 1. Contact the Veteran and take all necessary steps to acquire his private treatment records, to include those from Dr. L. and Dr. D. 2. Obtain the Veteran’s VA treatment records from December 19, 2018, to the present. 3. Assign an appropriate VA examiner to determine the nature and etiology of the Veteran’s thyroid cancer. The electronic claims file must be reviewed by the examiner. After a review of the claims file, the examiner should provide answers to the following question: Is it at least as likely as not (50 percent probability or greater) that the Veteran’s thyroid cancer, had its onset in service or is caused by or related at least in part to his active service? The examiner’s opinion should include a discussion regarding the Veteran’s exposure to Agent Orange and contaminated water at Camp Lejeune. The examiner’s opinion must also discuss the National Academy of Sciences (NAS) Institute of Medicine’s Veterans and AO: Update 2014 (2014 Update) that concluded that there is “limited or suggestive evidence of an association” between hypothyroidism and herbicide. The VA examination report must include a complete rationale for all opinions expressed. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Rescan, 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.