Citation Nr: 21020903 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 16-39 721 DATE: April 8, 2021 ORDER Entitlement to service connection for Graves’ Disease is granted. Entitlement to service connection for a cardiac condition secondary to Graves’ Disease is granted. FINDINGS OF FACT 1. The Veteran’s Graves’ Disease had its onset during active military service. 2. The Veteran’s cardiomyopathy is proximately due to or caused by a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for establishing entitlement to service connection for Graves’ Disease are met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for a cardiac disorder have been met. 38 U.S.C. §§ 1131; 38 C.F.R. § 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from December 1979 to November 1981. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2021, the Veteran testified during a video hearing before the undersigned Veterans Law Judge; a transcript of the hearing is of record. Entitlement to Service Connection for Graves’ Disease Entitlement to service connection on a direct basis requires (1) evidence of current nonservice-connected disability; (2) evidence of in-service incurrence or aggravation of disease or injury; and (3) evidence of a nexus between the in-service disease or injury and the current nonservice-connected disability. 38 C.F.R. § 3.303(a); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). A July 1985 letter from a VA physician (specifically, an endocrinologist,) describes the Veteran’s diagnosis as “Graves’ Disease with cardiomyopathy,” and states that “the initial manifestation of this disease began in 1981 with severe weight loss and fatigue while he was in the military.” The physician went on to say that because the Veteran’s condition was untreated for so many years, he was “one of the most severely thyrotoxic patients [the physician had] treated” at that hospital, and that the Veteran had to receive inpatient treatment, which the physician claimed was not typically necessary for Graves’ Disease. If the information in this letter is taken as true, the Veteran has met all of the requirements for service connection: a diagnosed disability, a manifestation of symptoms in service, and a link between those symptoms and his current diagnosis. In fact, the record does appear to corroborate this letter. VA treatment records show that the Veteran was hospitalized for a hyperactive thyroid in January 1985, and was diagnosed with Graves’ disease based on his then-current symptoms and the medical history he gave to providers. The Veteran described himself as having been in good health until early 1981, when he began experiencing fatigue, low mood, excessive sweating, and rapid weight loss despite a heightened appetite. The Veteran’s service treatment records (STRs) document a clinic visit in September 1981, during which the Veteran presented as “anxious, sweaty, and fatigued.” The Veteran’s VA treatment records also establish why the Veteran delayed seeking treatment after leaving service; in January 1981, the Veteran stated that he had misplaced his discharge papers and could not afford to seek private medical treatment. After applying for new copies of his discharge papers, he located the originals and went to a VA medical center the next day, at which point he was immediately hospitalized. Furthermore, the July 1985 physician letter states that “it is well known that hyperthyroidism produces a variety of psychoses in patients varying from depression and mania to schizoid changes. It certainly can affect judgment.” The Veteran entered active service in December 1979, and his military personnel records show no disciplinary problems during his first 11 months of service. Then, beginning in November 1980, the Veteran suddenly began receiving frequent citations for offenses such as tardiness, poor behavior, inattention to duty, and low motivation. The Veteran’s STRs show that, on more than one occasion, the Veteran displayed anxiety, depression, rage, and suicidal ideation, with no clear explanation for his disordered moods. During his February 2021 hearing, the Veteran recalled that his physical and mental health improved dramatically after he began receiving treatment for his Graves’ Disease in 1985. As the July 1985 letter was written by a medical professional with relevant expertise, is supported by adequate reasoning and corroborated by the other evidence of record, the Board finds that the letter is probative evidence entitled to great weight. The Board finds that the preponderance of the evidence shows that the Veteran has Graves’ Disease that had its onset during active service. Entitlement to service connection for Graves’ Disease is granted. Entitlement to Service Connection for a Cardiac Condition Secondary to Graves’ Disease A disability which is proximately due to or the result of a service-connected disease or injury may itself be service connected. 38 C.F.R. § 3.310(a). Establishing secondary service connection requires competent medical or lay evidence of: (1) a current disability that is not already service connected; (2) at least one service-connected disability; and (3) a nexus between the current disability and the service-connected disability, showing that the current disability was either proximately due to or the result of the service-connected disability or that the current disability was aggravated beyond its natural progression by the service-connected disability. Id.; Allen v. Brown, 7 Vet. App. 439 (1995). In determining whether service connection is warranted for a disability, VA is responsible for deciding whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the preponderance of evidence is against the claim, in which case the claim must be denied. 38 U.S.C. § 5107 ; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The January 1985 letter describes the Veteran as having cardiomyopathy related to his Graves’ Disease, and states that the progression of the Veteran’s Graves’ Disease for three years without treatment “accounts for his cardiac involvement.” The letter gave the following description of the Veteran’s heart condition: Although he looks the picture of health, he has four chamber enlargement of the heart and marked left ventricular hypokinesis—that is, the most important part of the heart is flabby. The Board finds the opinion stated in the January 1985 letter to be credible, for reasons discussed in the previous section, and therefore finds that the Veteran has a diagnosed heart condition that is at least as likely as not caused by his service-connected Graves Disease. Entitlement to service connection for a cardiac condition is granted. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Shermila Sundquist 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.