Citation Nr: 21041546 Decision Date: 07/09/21 Archive Date: 07/09/21 DOCKET NO. 17-31 816 DATE: July 9, 2021 ORDER Entitlement to service connection for medullary thyroid cancer is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran's medullary thyroid cancer was incurred in or due to his time in service. CONCLUSION OF LAW The criteria for entitlement to service connection for medullary thyroid cancer have not been met. 38 U.S.C. §§ 1110, 1116, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from May 1975 to May 1978 and from February 1981 to September 1986. This matter was previously before the Board in February 2021, at which time it was remanded to the Department of Veterans Affairs (VA) Regional Office (RO) for further development. The RO most recently readjudicated the appeal in an April 2021 supplemental statement of the case. The Board finds that VA has substantially complied with the February 2021 Board remand. Entitlement to service connection for medullary thyroid cancer The Veteran alleges that his current medullary thyroid cancer is etiologically related to his active duty service. Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. In order to establish service connection for the claimed disorder, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). Certain chronic diseases, such as organic diseases of the nervous system to include tinnitus, may be presumed to have been incurred during service if they become manifested to a compensable degree within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309; see also 67 Fed. Reg. 67792 -67793 (Nov. 7, 2002). Service connection can also be established on the basis of continuity of symptomatology. Continuity of symptomatology may be shown by demonstrating "(1) that a condition was 'noted' during service or any applicable presumption period; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology." Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). However, the Federal Circuit held that the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic in 38 C.F.R. § 3.309(a), such as organic diseases of the nervous system to include tinnitus. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. 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; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). At the outset, the Board notes that the Veteran has a diagnosis of medullary thyroid cancer. See March 2021 VA examination. The Veteran was diagnosed with medullary thyroid cancer in 2007, decades following his separation from service. The Veteran's service treatment records are silent for a diagnosis of thyroid cancer. In-service records from April 1978 indicate a recurring mass in his right neck referred to as a branchial cleft cyst which was removed. The Veteran's enlistment examination for his second period of active duty service also references the Veteran's 1978 neck procedure but otherwise deems the Veteran in good health. Treatment notes from 1983 indicate that the Veteran had a small metal fragment removed from the right side of the neck. There are no other indications of neck problems and no diagnosis or treatment for thyroid cancer while in service. The Veteran maintains that his thyroid condition is secondary to radiation while on active duty fixing aircraft. The Veteran's military personnel file confirms that the Veteran had time working on, inspecting, and fixing aircraft. In August 2013, the Chief of Radiological Health Operations submitted a statement regarding the Veteran's radiation exposure. The Chief noted that the Veteran did have potential for exposure but that he was unable to determine what specific exposure may have resulted for the Veteran. The Chief said that over 46,000 dosimetric readings were retrieved for the Veteran's MOS and that about five percent of them had exposure to any measurable dose and only.1 percent had lifetime doses greater than .300 rem. The Chief noted the average annual exposure for people in the U.S. was approximately .620 rem. The Chief said that the consensus of scientific advisory bodies is that "there are no long-term effects (including cancer) from low-level exposures to radiofrequency radiation." Following the February 2021 remand, the Veteran was provided with a VA examination for thyroid and parathyroid conditions in March 2021. The examiner diagnosed the Veteran with malignant neoplasm of the thyroid, diagnosed in 2007, as well as hypothyroidism and hypothyroidism. The examiner noted that in 2007 the Veteran experienced dysphagia which prompted him to seek treatment. The Veteran underwent treatment for the condition, to surgeries as recent as 2017. The Veteran was found to be on thyroid replacement and calcium and was not showing any symptoms of hypothyroidism or hyperthyroidism at the time of the examination. After thoroughly reviewing the Veteran's records, the examiner opined that it was less likely than not that the Veteran's current medullary thyroid cancer and residual were etiologically related to the Veteran's active duty service. After reviewing the Veteran's claims file and examining the claims file the examiner could not find anything to indicate that the Veteran's medullary thyroid cancer, diagnosed in 2007 is etiologically related to service. Of note, the examiner also opined that it was less likely than not that the Veteran's medullary thyroid cancer was proximately due to or the result of any of the Veteran's service-connected disabilities. Simply stated, the February 2021 examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Significantly, there is no other competent medical opinion of record to the contrary. The Board acknowledges the Veteran's statements that he believes his conditions are all due to his time in service. The Board also acknowledges the Veteran sought medical treatment for these conditions. However, while the Veteran is competent to report the symptoms of his disabilities, he is not competent to opine on matters requiring medical knowledge, such as determining the nature and etiology of his medical condition. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). While the Veteran may disagree with the types of cancers that are subject to presumptive service connection, he is not a medical professional qualified to discuss the differences in the types of cancers or the cause of his cancer. It is important for the Veteran to understand that the most probative medical findings of record provide evidence against these claims that the Board cannot, unfortunately, ignore, outweighing the Veteran's belief that his disabilities are the result of service decades ago, providing a highly clear basis for the opinion. Therefore, the Board has weighed the medical evidence as discussed above and must deny the claims. Regarding all the above, the Board has considered the applicability of the benefit of the doubt doctrine. Because the preponderance of the evidence is against the Veteran's claim, the benefit of the doubt doctrine does not apply. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57(1990). John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board V. Woehlke 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.