Citation Nr: 21020809 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 18-44 785 DATE: April 8, 2021 ORDER Service connection for hypothyroidism is denied. FINDING OF FACT The Veteran’s hypothyroidism did not begin during or within the initial year after separation and is not related to any incident of service, including radiation exposure. CONCLUSION OF LAW The criteria for service connection for hypothyroidism are not met. 38 U.S.C. §§ 1110, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.311. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1957 to April 1961. This case comes to the Board from a March 2016 rating decision In December 2015, the Veteran testified at a Board hearing. Most recently for this appeal, in October 2020, the Board reopened a previously denied claim of service connection for traumatic brain injury (TBI). At that time, the Board also remanded the reopened claim and the hypothyroidism claim for additional development. While the case was in remand status, by rating decision in January 2021, the RO granted service connection for TBI. This represents a full grant of the benefit sought with respect to that issue and it is no longer on appeal. By rating decision February 2021, the RO implemented the Board’s grant of service connection for liver disease as a result of in-service radiation exposure. This represents a full grant of the benefit sought with respect to that issue. Additional evidence was received subsequent to the most recent supplemental statement of the case issued in January 2021. As the evidence is not pertinent to the claim on appeal, a remand for RO consideration of the evidence is not necessary. See 38 C.F.R. § 20.1305(c). The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Service connection for hypothyroidism. Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: “(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 or aggravated during service.” Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Certain chronic diseases, including endocrinopathies, will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). VA regulations also provide for service connection for radiation exposed veterans on three different legal bases. The first basis is a presumptive basis for diseases specific to radiation exposed veterans under 38 C.F.R. § 3.309(d). The second is based on exposure to ionizing radiation with the subsequent development of a radiogenic disease as provided in 38 C.F.R. § 3.311. A veteran is also entitled to service connection if he can establish that a disability warrants service connection on a direct or presumptive basis. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Analysis The Veteran maintains that his current hypothyroidism is a result of in-service environmental exposures, to include ionizing radiation; non-ionizing radiation, including in the form of UV light from the sun; uranium, both highly-enriched and depleted; and metallic lead, in association with duties as an aircraft maintenance technician at various Air Force bases, including on the flight line, while stationed with the Strategic Air command (SAC), to include maintenance of B-47’s loaded with atomic weapons, and loading and unloading nuclear weapons from planes. In addition, he maintains exposure while helping to clean up a radioactive crash site after a B-47 crashed at Dyess Air Force Base in 1958. In that respect, the record reflects a current diagnosis of hypothyroidism. See December 2020 VA examination report. As such, the current disability element is established. In addition, and although the Veteran’s complete service records are unavailable, the record establishes in-service radiation exposure. An October 2017 letter from the Director, Compensation service, reflects an ionizing radiation dose estimate of less than 5 rem during service. As noted above, by rating decision in January 2021, service connection was granted for liver disease as a result of exposure to radiation during service. Thus, an in-service injury is established. As such, the question is whether the Veteran’s current hypothyroidism is related to service, to include in-service radiation exposure. Although hypothyroidism is not listed as a presumptive disease associated with radiation exposure under 38 C.F.R. § 3.311, the Veteran is not precluded from establishing service connection on a direct basis. See 38 U.S.C. § 1113(b); 38 C.F.R. § 3.303(d) (the availability of service connection on a presumptive basis does not preclude consideration of service connection on a direct basis); Combee, 34 F.3d at 1039. In that respect, pursuant to the Board’s October 2020 remand, a VA opinion was obtained in December 2020. The examiner stated that the Veteran’s hypothyroidism is less than likely related to service, including radiation exposure, noting no reference to hypothyroidism during service or within the initial year after separation. Further, the examiner noted insufficient evidence in medical literature linking hypothyroidism to nonionizing or ionizing radiation, including metallic lead and uranium, both highly enriched and depleted. Although high doses of irradiation were noted to be associated with the risk of hypothyroidism, according to the EPA, no effects for radiation exposure were observed for radiation doses of less than 5 rem per year, as in the Veteran’s case. In addition, it was noted that the CDC did not list a relationship between hypothyroidism and metallic lead. The examiner added that most cases of hypothyroidism are caused by iodine deficiency, or autoimmunity. Further, none of the medical literature the Veteran cited establishes that the Veteran’s hypothyroidism is related to any form of radiation or other environmental exposure during service. Although a March 2014 record notes a history of hypothyroidism, see February 2016 Medical Treatment Record, such does not establish that hypothyroidism had its onset during service or within the initial of separation or is otherwise related to service, including environmental exposures. The Board notes that, although the Veteran is competent to report his symptoms, a determination as to whether the Veteran’s hypothyroidism is related to service is a complex matter requiring related medical expertise. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (holding that a lay person is not considered competent to testify regarding medically complex issues). As the Veteran has no known or reported medical expertise, he is not legally competent to establish a nexus between hypothyroidism and service; thus, his opinion as to causation lacks probative value, and an opinion by a qualified medical professional is required to decide the claim. In that regard, the opinion rendered by the VA examiner constitutes such competent medical evidence. Further, as this opinion is unequivocally stated, consistent with the record, and supported by cited evidence of record, the Board finds that this medical opinion is probative evidence against the Veteran’s claim. That is, the medical evidence outweighs the Veteran’s report of recurrent symptoms and his lay opinion on the matter, even if such a theory is intuitively plausible to a lay person. In sum, the record confirms that the Veteran had environmental exposures during service, including radiation, and currently has hypothyroidism; however, the evidence does not show complaints of or treatment for hypothyroidism during service or to a compensable degree within one year after separation, and the competent post-service evidence does not link the Veteran’s hypothyroidism, to service or any incident of service, including radiation exposure. As such, the Board finds the preponderance of the evidence is against the claim and thus, the benefit-of-the-doubt doctrine does not apply. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Therefore, service connection for hypothyroidism is not warranted. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Taylor 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.