Citation Nr: 21042355 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 18-10 459 DATE: July 12, 2021 ORDER Service connection for iatrogenic hypothyroidism, status-post Graves' disease, is granted. FINDING OF FACT Resolving all doubt in the Veteran's favor, his current thyroid disorder, diagnosed as iatrogenic hypothyroidism, status-post Graves' disease, is related to his exposure to contaminated water at Camp Lejeune. CONCLUSION OF LAW The criteria for service connection for iatrogenic hypothyroidism, status-post Graves' disease, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty for training from August 1973 to December 1973 and on active duty from August 1974 to November 1975. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in June 2015 by a Department of Veterans Affairs (VA) Regional Office. In March 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. At such time, the Veteran waived Agency of Original Jurisdiction consideration of the evidence associated with the record since the issuance of the December 2017 statement of the case. 38 C.F.R. § 20.1305(c). Entitlement to service connection for a thyroid disorder. The Veteran alleges his current thyroid disorder, diagnosed as iatrogenic hypothyroidism, status-post Graves' disease, is due to his in-service exposure to contaminated water while stationed at Camp Lejeune in North Carolina. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996). With respect to a current disability, an April 2015 letter from a private physician, Dr. M.R., shows the Veteran was undergoing care for iatrogenic hypothyroidism as a result of treatment of Graves' disease, and a March 2016 letter from Dr. M.R. indicates a diagnosis of Graves' disease in November 2010. Additionally, the Veteran's service personnel records confirm his service at Camp Lejeune from August 1974 to November 1975. In this respect, VA acknowledges that persons residing or working at the U.S. Marine Corps Base Camp Lejeune from August 1, 1953, through December 31, 1987, were potentially exposed to drinking contaminated water with volatile organic compounds. See Veterans Benefits Administration Fast Letter 11-03 (January 11, 2011). In this regard, VA has established a presumption of service connection for certain diseases for veterans, former reservists, and former National Guard members who were exposed to contaminants in the water supply while serving at Camp Lejeune for no less than 30 days (either consecutive or nonconsecutive) from August 1, 1953, to December 31, 1987. See 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Specifically, there is a presumption of service connection for kidney cancer, liver cancer, Non-Hodgkin's lymphoma, adult leukemia, multiple myeloma, Parkinson's disease, aplastic anemia and other myelodysplastic syndromes, and bladder cancer, which have become manifest to a degree of 10 percent or more at any time after service if the veteran was stationed at Camp Lejeune during the designated period. Notably, Graves' disease is not a disorder for which presumptive service connection is provided; nevertheless, the Veteran is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). Therefore, the remaining question is whether the Veteran's current thyroid disorder is directly related to his acknowledged in-service exposure to contaminated water. In the March 2016 letter, Dr. M.R. reported that the Veteran was diagnosed with Graves' disease in November 2010 and underwent radioactive iodine therapy in December 2010. Dr. M.R. found pertinent that the Veteran had no personal or family history of thyroid disease prior to his diagnosis and highlighted his history of exposure to toxic chemicals infiltrating the ground water at Camp Lejeune. Dr. M.R. also reported that literature research yielded no specific information on the topic. Based on the above, Dr. M.R. concluded that "it is as least likely as not that the exposure may be related to his diagnosis." Conversely, a VA physician reviewed the record and opined the Veteran's thyroid condition is less likely as not caused by or a result of his exposure to contaminated water at Camp Lejeune. In support thereof, he noted that there is no reference to any type of thyroid disorders in the Agency for Toxic Substances and Disease Registry, which notes several diseases may have resulted from exposure to contaminated water at Camp Lejeune. Additionally, the medical literature has no studies regarding TCE, PCE, or other volatile organic substances as a cause of Grave's disease. However, the VA physician also noted that, although medical literature cites several risk factors for the development of Grave's disease, to include stressful life events, high iodine intake, drugs, palpation thyroiditis, and thyroid injury, none of those risk factors were present in the Veteran's case. Additionally, he erroneously reported that the Veteran was stationed at Camp Lejeune for approximately 90 days in 1973, which minimizes the Veteran's potential amount of exposure to contaminated water. Upon review, the Board finds that the evidence of record is at least in equipoise as to whether the Veteran's current thyroid disorder, diagnosed as iatrogenic hypothyroidism, status-post Graves' disease, is related to his acknowledged in-service exposure to contaminated water. Specifically, both of the aforementioned physicians are competent medical professionals who considered the Veteran's individual case and accepted medical principles, and provided rationales for the opinions. Thus, their opinions are entitled to probative weight. Furthermore, as acknowledged by both physicians, the Veteran had no other risk factors for the development of Graves' disease and the medical literature has not specifically addressed whether such may be related to contaminated water at Camp Lejeune. Consequently, the Board resolves all doubt in the Veteran's favor and finds that his current thyroid disorder, diagnosed as iatrogenic hypothyroidism, status-post Graves' disease, is related to his exposure to contaminated water at Camp Lejeune. Therefore, service connection for such disorder is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. M. Celli, 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.