Citation Nr: 21020797 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 18-10 682 DATE: April 8, 2021 REMANDED Entitlement to an evaluation in excess of 10 percent for thyroid cancer, status post thyroidectomy, two radical neck dissections, and radioactive iodine, with residual hypothyroidism (thyroid disability) is remanded. REASONS FOR REMAND The Veteran served on active duty from December 2007 to December 2015. This matter is before the Board of Veterans’ Appeals (Board) on appeal of a May 2016 rating decision by a Department of Veterans Affairs (VA) regional office. In May 2020, the Veteran appeared at a hearing before the undersigned Veterans Law Judge. This issue was remanded by the Board in July 2020. Effective December 10, 2017, the rating criteria governing hypothyroidism was significantly changed. See 82 Fed. Reg. 50802 (Nov. 2, 2017). The new rating criteria depends upon the presence or absence of 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)). Under the old criteria, a 10 percent rating was assigned when continuous medication was required to control hypothyroidism. A 30 percent rating required fatigability, constipation, and mental sluggishness. A 60 percent rating required muscular weakness, mental disturbance, and weight gain. A 100 percent rating required cold intolerance, muscular weakness, cardiovascular involvement, mental disturbance (dementia, slowing of thought, depression), bradycardia (less than 60 beats per minute), and sleepiness. The Veteran’s claim was pending prior to the effective date of the regulation change and the old and the new rating criteria are potentially applicable to his claim. In July 2020, the Board remanded the case for a new VA examination addressing the severity of the Veteran’s symptoms under both the old and current rating criteria. An examination was afforded in November 2020. After examination and review of the file, the examiner stated that he could not state with more than 50 percent certainty if the Veteran’s symptoms are attributable to the thyroid disability. The evidence need only be in equipoise; that is, 50 percent or greater probability for VA purposes. 38 C.F.R. § 3.102. Thus, the examiner did not consider the appropriate standard. In addition, the VA examiner, a doctor specializing in emergency medicine, stated an expert in endocrinology would be helpful in settling the issue of whether the Veteran’s reported symptoms are attributable to his thyroid disability. Given the above, remand is necessary for an opinion by someone with endocrinology expertise. (Continued on the next page.) The matter is REMANDED for the following action: 1. Ensure that any updated, relevant treatment records are associated with the file. 2. After records development is completed, schedule the Veteran for a VA thyroid examination by an examiner with expertise in endocrinology to determine the current symptoms, level of severity, and functional impairment associated with his thyroid disability. The claims file should be reviewed by the examiner. The examiner should specifically comment on the thyroid disability based upon both the rating criteria in effect before December 10, 2017 and the current rating criteria under Diagnostic Code 7903. Specifically, the examiner is asked to comment on: (a) Whether the Veteran has fatigability, constipation, and mental sluggishness. (b) Whether the Veteran has muscular weakness, mental disturbance, and weight gain. (c) Whether the Veteran has cold intolerance, muscular weakness, cardiovascular involvement, mental disturbance (dementia, slowing of thought, depression), bradycardia (less than 60 beats per minute), and sleepiness. (d) Whether the hypothyroidism manifests 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)). (e) All residual effects of hypothyroidism (e.g., eye, digestive, mental disorders). Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Russell P. Veldenz, 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.