Citation Nr: 21027269 Decision Date: 05/05/21 Archive Date: 05/05/21 DOCKET NO. 15-17 213 DATE: May 5, 2021 REMANDED Entitlement to an increased rating for hypothyroidism to include all associated symptomatology is remanded. REASONS FOR REMAND The Veteran served on active duty from September 2001 to March 2008. This case is before the Board of Veterans' Appeals (Board) on appeal from a November 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In March 2018, the Veteran testified before a Veterans Law Judge (VLJ) at a Board hearing. However, the VLJ who conducted the hearing is no longer available to participate in the Veteran's appeal. The Veteran was given another opportunity to appear at a hearing before a VLJ who would decide the claim. See January 2020 letter from the Board. The Veteran did not invoke his right to appear at an additional hearing, and as such, the Board will proceed with adjudication. See March 2020 Third Party Correspondence. This claim was remanded in September 2018 and again in March 2020 to obtain examinations to assess the current severity of the Veteran's hypothyroidism as he had alleged worsening on both occasions and the medical records demonstrated that his symptoms had increased in severity. Entitlement to an increased rating for hypothyroidism to include all associated symptomatology is remanded. The Veteran is seeking an increased rating for his service-connected hypothyroidism. The Veteran's original evaluation was assigned under a prior version of DC 7903. The criteria for rating hypothyroidism under DC 7903 were amended, effective December 10, 2017. 82 Fed. Reg. 50802 (November 2, 2017). When the applicable regulation changes during an appeal, the Veteran is entitled to resolution of the claim under the criteria more advantageous. The old criteria can apply to the entire appeal period, but new criteria can only apply as to the effective date of the change. The prior version of DC 7903 provided a 10 percent rating for hypothyroidism where it is manifested by fatigability or where continuous medication is required for control. A 30 percent rating was warranted for fatigability, constipation, and mental sluggishness. A 60 percent rating was warranted for muscular weakness, mental disturbance, and weight gain. A 100 percent rating was warranted for cold intolerance, muscular weakness, cardiovascular involvement, mental disturbance (dementia, slowing of thought, depression), bradycardia (less than 60 beats per minute), and sleepiness. 38 C.F.R. § 4.119, DC 7903. In Tatum v. Shinseki, 23 Vet. App. 152, 155 (2009), the Court stated that the rating criteria for DC 7903 are not successive, explaining that a claimant could potentially establish all the criteria required for a 30 percent or 60 percent rating without establishing any of the criteria for a lesser disability rating. Id. at 156. The current version of the criteria, effective December 10, 2017, provide that a 100 percent rating is assigned for hypothyroidism manifesting 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)) for a period of six months after an examiner has determined the condition is stabilized. Thereafter, the residual effects of hypothyroidism are rated under the appropriate diagnostic code(s) within the appropriate body system(s) (e.g., eye, digestive, and mental disorders). For hypothyroidism without myxedema, a 30 percent rating is assigned for six months after initial diagnosis. Thereafter, residuals of disease or medical treatment are rated under the most appropriate diagnostic code(s) under the appropriate body system (e.g., eye, digestive, mental disorders). 38 C.F.R. § 4.119, DC 7903. Currently, the Veteran's hypothyroidism is evaluated as 60 percent disabling prior to December 10, 2017 (the date DC 7903 was amended); and since that time, the AOJ evaluated the Veteran's residuals of his hypothyroidism separately, assigning a 70 percent evaluation for generalized anxiety disorder and a 10 percent rating for dermatitis, tinea cruris and cold intolerance. During an August 2020 VA examination, the examiner specifically stated that the Veteran's current symptoms of hypothyroidism manifested as myxedema (a term used to denote severe hypothyroidism) and mental disturbance, (to include slowing of thought and depression), which necessitates a 100 percent evaluation for a period of six months after an examiner has determined that the condition has stabilized. However, in this case, the examiner failed to address whether the Veteran's condition had stabilized. This information is necessary to determine the appropriate rating pursuant to the current version of the rating criteria effective December 10, 2017. See 38 C.F.R. § 4.119, DC 7903, Note (1). Only after the period of stabilization would the Veteran be rated for his relevant symptomatology. Thus, on remand, the AOJ must obtain an addendum opinion. The matter is REMANDED for the following actions: 1. Associate any outstanding VA treatment records with the claims file. 2. Obtain an addendum to the August 2020 VA examination. Ask the examiner, if available, to determine whether the Veteran's myxedema has stabilized. If the August 2020 examiner is not available, an opinion should be obtained from a similarly qualified medical professional. If an in-person examination is necessary, such should be afforded to the Veteran. 3. On remand, the AOJ should consider the old rating criteria for DC 7903 for the entirety of the appeal period. Jennifer White Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Alison M. Mecone, 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.