Citation Nr: 22008030 Decision Date: 02/11/22 Archive Date: 02/11/22 DOCKET NO. 18-20 856 DATE: February 11, 2022 REMANDED Entitlement to an initial disability rating in excess of 10 percent for service-connected hypothyroidism is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1993 to September 2016. In August 2021, she testified before the undersigned Veterans Law Judge via video conference. In the December 2016 rating decision on appeal, the Agency of Original Jurisdiction (AOJ) granted service connection for hypothyroidism and assigned an initial 10 percent rating pursuant to 38 C.F.R. § 4.119, DC 7903, effective October 1, 2016. The Veteran seeks a higher rating for her service-connected disability. The AOJ last adjudicated this appeal in a February 2018 statement of the case (SOC), but since the issuance of the SOC, the rating criteria to rate hypothyroidism were changed, effective December 10, 2017. When the applicable regulation changes during an appeal, the Veteran is entitled to resolution of the claim will be considered under both the old and new rating criteria, and whichever criteria is more favorable to the Veteran will be applied, although the new criteria can apply only as of the effective date of the change. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). 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. Under the amended criteria, effective December 10, 2017, a 30 percent rating is assigned for hypothyroidism without myxedema for six months after the 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). 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)). The 100 percent rating shall continue for six months beyond the date that an examining physician has determined crisis stabilization. Thereafter, the residual effects of hypothyroidism shall be rated under the appropriate diagnostic code(s) within the appropriate body system(s). The physician who conducted the September 2016 VA examination noted that the Veteran had intermittent difficulty with stabilization of her hormone level with medication changes over time but that she was doing well on her current medication. The evidence also reflects that the Veteran has endorsed experiencing mental fog, sluggishness, emotional instability, difficulty concentrating, fatigue, and sleepiness during the appeal period. The Board finds a remand is needed in order to schedule the Veteran a VA examination in order for a physician to determine when crisis stabilization occurred in the case of this Veteran and for a physician to determine if the symptoms identified by the Veteran are, in fact, attributable to her service-connected hypothyroidism. A remand will also afford the AOJ an opportunity to adjudicate this claim under the prior and amended version of DC 7903, but with consideration of the new rating criteria not before the effective date of December 10, 2017. The matter is REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the severity and manifestations of her service-connected hypothyroidism. The claims file must be provided to the examiner and the examination report must reflect that review of the file was accomplished. (a) The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the appropriate rating criteria. The examiner must specifically state if the Veteran's mental fog, sluggishness, emotional instability, difficulty concentrating, fatigue, and sleepiness are attributable to her thyroid disability. (b) After review of the record, the examiner must determine when crisis stabilization occurred in this case. All examination findings, along with the complete rationale for all opinions expressed, must be set forth in the examination report. 2. After undertaking any additional development deemed appropriate and giving the Veteran full opportunity to supplement the record, adjudicate the Veteran's pending claim in light of any additional evidence added to the record. If any benefit sought on appeal remains denied, the Veteran and his representative should be furnished with a Supplemental Statement of the Case and be afforded the applicable opportunity to respond before the record is returned to the Board for further review. M. Donohue Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Turnipseed, 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.