Citation Nr: 21023708 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 17-42 629 DATE: April 21, 2021 REMANDED Entitlement to service connection for right hemithyroidectomy, to include thyroid cancer is remanded. REASONS FOR REMAND The Veteran served on active duty in the Marine Corps from July 1982 to August 1985 to include being stationed at Camp Lejeune, North Carolina. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a January 2015 rating decision. In a May 2019 decision, the Board decided that new and material evidence was submitted to reopen the claim. The Board in the same decision that reopened the claim denied service connection on the issue. The Veteran appealed the Board’s May 2019 denial of service connection to the Court of Appeals for Veteran’s Claims (Court) in October 2019, which resulted in an August 2020 Court remand, that brings the issue back to the Board. Entitlement to service connection for right hemithyroidectomy, to include thyroid cancer is remanded. The Veteran contends that his thyroid condition is related to exposure to contaminated water at Camp Lejeune. The Board based its May 2019 denial of service connection for the Veteran’s thyroid condition on a July 2013 medical opinion which the Court found inadequate for several reasons. First the examiner noted that the record contained no diagnosis of thyroid cancer, a finding that is inconsistent with the July 1991 Board decision and the June 1993 Court decision, which both noted that the pathology for the Veteran’s thyroid tumor was unknown. The examiner’s rationale is based entirely on reviewing medical literature and assessing the Veteran’s risk factors for thyroid cancer, without explaining whether that information would be equally relevant if the thyroid tumor was benign. Second, the July 2013 examiner reviewed several medical research studies regarding thyroid cancer and its link to known environmental exposures. Although the examiner stated that she found no studies linking thyroid cancer to exposure to chemicals, she indicated that the research literature established a link between thyroid cancer and exposure to diagnostic radiation, electromagnetic fields, and impregnating agents. However, the examiner did not explain how these studies were relevant to the question of the etiology of the Veteran’s thyroid tumor, as there is no evidence that he was exposed to diagnostic radiation, electromagnetic fields, or impregnating agents. The June 1993 Court decision specifically noted no history of radiation exposure. Third, the examiner reviewed several additional risk factors for thyroid cancer including smoking history, alcohol use, obesity, and genetics. In this regard, the examiner noted "cigar use," no alcohol use, a current weight of 211.5 pounds, and no family history of cancer. However, the examiner did not explain the import of her notations or how this assessment of the Veteran's risk factors contributed to her overall opinion. Specifically, it appears that alcohol use and family history were not factors, but it is unclear how the examiner's consideration of the Veteran's "cigar use" and his current weight factored into her decision. It was particularly unclear to the Court how the Veteran's weight in 2013 was relevant to determining whether obesity was a factor in the development of his thyroid tumor in 1989. For the above reasons, the Board is remanding the issue for a new medical opinion. In support of his claims, the Veteran submitted several articles and reports in January 2021, about contaminated water at Camp Lejeune, which the examiner must read, consider, and discuss in the requested opinion. The matters are REMANDED for the following action: 1. Obtain any VA treatment records for the Veteran which are not already associated with the record. 2. Ask the Veteran to complete a VA Form 21-4142 for each physician or facility where he sought treatment and underwent surgery for his thyroid disability. Make two requests for the authorized records from any physician or facility authorized by the Veteran unless it is clear after the first request that a second request would be futile. 3. Forward the claims file to an appropriate clinician to determine the nature and etiology of his claimed thyroid disability. An examination should be scheduled only if deemed necessary by the examiner. After review of the claims file the examiner should opine as to the following: a) whether it is at least as likely as not (50 percent probability or greater) related to an in-service injury, event, or disease, including exposure to contaminants in the water supply at Camp Lejeune. The examiner must discuss whether the Veteran had thyroid cancer, and if not, how a benign tumor would impact risk factors noted in medical literature. The examiner must also discuss the Veteran’s risk factors, specifically the risk factors in 1989 at the time of diagnosis and clearly explain how these factor into the decision. b) whether it is at least as likely as not (50 percent probability or greater) (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. Each medical opinion must include a sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting clinical data. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Black, Associate 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.