Citation Nr: 21023060 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 13-33 017 DATE: April 20, 2021 REMANDED Entitlement to an initial rating in excess of 10 percent for hypothyroidism prior to December 10, 2017, and in excess of 30 percent, thereafter, is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1996 to January 2000. This matter comes before the Board of Veterans’ Appeals (the Board) on appeal from a July 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded this matter in December 2017 for further development. While in remand status, the RO issued a January 2021 rating decision, increasing the Veteran’s rating for hypothyroidism to 30 percent, effective December 10, 2017. The Veteran continues to appeal for a higher rating. AB v. Brown, 6 Vet. App. 35 (1993) (a claimant is presumed to be seeking the maximum rating allowed by law). Unfortunately, as explained below, the Board is not satisfied there was substantial compliance with its prior remand; therefore, the appeal must be remanded once again. See Stegall v. West, 11 Vet. App. 268, 271 (1998); D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). Pursuant to its December 2017 remand, the Board directed the RO to obtain all outstanding VA and private treatment records pertinent to the Veteran’s claim, and to obtain a VA examination and opinion to assess the current severity of the Veteran’s hypothyroidism. There is no indication in the file that the RO made any attempts to obtain the Veteran’s outstanding VA treatment records, nor is there a determination that no such records exist. VA has a duty to assist veterans in the development of their claims. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. The Board also directed the RO to obtain a VA examination and opinion regarding the current severity of the Veteran’s hypothyroidism. The examiner was asked to identify and address all manifestations of the Veteran’s hypothyroidism, to include, the Veteran’s specifically alleged symptoms such as: fatigue or tiredness; sleepiness; mental sluggishness; constipation; weight gain issues; low heart rate; loss of hair; brittle nails; sensitivity to cold; menstruation problems; and hoarse voice. The examiner’s opinion stated the Veteran’s claimed symptoms “could be caused by a vast number of conditions,” and that “some of th[e] symptoms can only be based on subjective report.” Further, the examiner noted hair loss as the Veteran’s only observed symptom. However, the examiner concluded that “[the area appeared to be caused by something other than the result of hypothyroidism,” and offered no other rationale. The examiner did not address the Veteran’s specifically alleged symptoms as directed by the Board and therefore the Veteran must be afforded a new VA examination so that an examiner can properly consider her claimed symptoms. Based on the above, the Board finds that the record does not contain a medical opinion that is sufficient to fairly decide the Veteran’s claim. Therefore, the claim must be remanded once again because the RO did not comply with the Board’s prior remand directives to obtain the Veteran’s outstanding VA treatment records, and to obtain an adequate VA medical opinion on behalf of the Veteran. See Stegall, 11 Vet. App. at 268. On remand, a new VA examination and opinion must be obtained that is adequate for the Board to make an informed decision on the Veteran’s claim. See Barr v. Nicholson, 21Vet. App.303, 311-12 (2007); Douglas v. Shinseki, 23Vet. App.19, 26 (2009). The matter is REMANDED for the following actions: 1. Obtain any outstanding VA treatment records and associate them with the claims file. Make as many requests as are necessary to obtain the records. If the records are deemed to be unavailable, the claims file must be annotated as such and the Veteran must be notified. 2. Request that the Veteran identify and provide authorization for VA to obtain any outstanding private treatment records pertinent to her hypothyroidism and related symptoms, including both recent records and records from during the entire course of her hypothyroid condition. See, e.g., Veteran’s April 2016 letter to the VA (citing to supporting statements by current, unnamed private endocrinologist). 3. Then, schedule the Veteran for an examination by an appropriate clinician to fully assess the current severity of the Veteran’s hypothyroidism. The examination should include any diagnostic testing or evaluation deemed necessary by the examiner. The entire claims file to include a copy of this REMAND, must be viewed by the examiner.  The examiner should answer the following: (a) Report the extent of the symptoms of the Veteran’s hypothyroidism in accordance with VA rating criteria. (b) Identify and address all manifestations of the Veteran’s hypothyroidism, to include the Veteran’s specifically alleged symptoms such as: fatigue or tiredness; sleepiness; mental sluggishness; constipation; weight gain issues; low heart rate; loss of hair; brittle nails; sensitivity to cold; menstruation problems; and hoarse voice. (c) Indicate whether the Veteran’s hypothyroidism disability results in symptoms of fatigability; the requirement for continuous medication for control; constipation; mental sluggishness; muscular weakness; mental disturbance (including with dementia, showing of thought, depression); weight gain, cold intolerance; cardiovascular involvement; bradycardia (less than 60 beats per minute); or sleepiness. (d) Indicate whether the Veteran’s symptoms indicate that her condition has become worse or improved during different time periods, making separate and distinct rating periods appropriate. A full and complete explanatory rationale must be provided for any opinion(s) offered. If the examiner is unable to provide an opinion without resorting to mere speculation, s/he should indicate whether this inability is due to lack of knowledge among the medical community or based on the lack of procurable information. The Board reminds the examiner that failure to comply with the directives outlined herein renders an examination report inadequate and will result in further remand of the Veteran’s claim. 4. Then, readjudicate the claim. Issue a supplemental statement of the case and allow the appropriate time for response. Then, return the case to the Board. Jenna Brant Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Gates 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.