Citation Nr: 22012138 Decision Date: 03/02/22 Archive Date: 03/02/22 DOCKET NO. 20-10 911 DATE: March 2, 2022 ORDER Entitlement to service connection for thyroid cancer is granted. FINDING OF FACT The Veteran's thyroid cancer had its onset in service. CONCLUSION OF LAW The criteria for service connection for thyroid cancer have been met. 38 U.S.C. § 1110; 38 U.S.C. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 2005 to November 2015. This case comes before the Board of Veterans' Appeals (Board) on appeal from a February 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO), which confirmed and continued the denial of service connection for thyroid cancer. The Veteran disagreed with the RO's determination, and a statement of the case (SOC) was issued in January 2020 addressing the matter. The Veteran timely appealed. The Veteran's claim of service connection for thyroid cancer was previously denied in a May 2017 rating decision and this denial did not become final; it is thus the rating decision from which the current appeal originates. Following the May 2017 rating decision, in January 2018, the Veteran submitted a letter from private Dr. M.W. dated in May 2017. This submission provided a positive opinion indicating that the Veteran's thyroid cancer began to develop prior to November 2015. As new and material evidence was received within a year of the May 2017 rating decision denying the claim of service connection for thyroid cancer, the rating decision did not become final, and the claim of service connection for thyroid cancer remained pending. 38 C.F.R. § 3.156 (b). In February 2022, the Veteran testified during a virtual hearing before the undersigned Veterans Law Judge (VLJ). Although a transcript of that hearing has not yet been made, one is not necessary in this case as the benefit sought is being granted in full. Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury or disease incurred in the active military, naval, air, or space service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Thyroid Cancer The Veteran contends that her thyroid cancer is related to her military service. In an alternative theory, she contends that such disability is secondary to her service-connected hyperthyroidism. For the following reasons, the Board finds that service connection for thyroid cancer is warranted on a direct basis. In this case, the evidence of record demonstrates that the requirement for a current disability has been met. Specifically, a December 2016 VA clinical record shows a diagnosis of thyroid cancer. Thus, the first element of service connection has been met. The Veteran's service treatment records (STRs) are negative of complaints, treatment, or diagnosis of thyroid cancer. At the Veteran's August 2015 separation examination, no pertinent abnormalities were noted. At her February 2022 Board hearing, the Veteran testified that her thyroid symptoms started in service and has continued since service. Here, the competent and credible lay statements from the Veteran demonstrates that her exhibited symptoms during service. This is sufficient to establish the second element of service connection claim. In January 2018, the Veteran submitted a letter from private Dr. M.W. dated in May 2017. Dr. M.W. opined that while it is impossible to definitively determine when the papillary carcinoma of the thyroid began, it is possible that the Veteran's thyroid cancer began to develop and grow prior to November 2015. Dr. M.W. noted that the Veteran underwent a total thyroidectomy and right neck dissection of February 17, 2017, and final pathology demonstrated a 3.2 cm papillary carcinoma in the right thyroid lobe with capsular and lymphovascular invasion, as well as metastatic papillary carcinoma in 5 cervical lymph nodes. In a June 2018, the Veteran submitted a letter from private Dr. J.H. dated in January 2018. Dr. J.H. opined that even though the Veteran was first diagnosed with thyroid cancer in late 2016, she likely had thyroid cancer for a few years before diagnosis. Dr. J.H. explained that papillary thyroid carcinoma often grows slowly over the years. In August 2018, the Veteran submitted a letter from private Dr. J.H. dated in July 2018. Dr. J.H. opined that it is more than likely the Veteran had thyroid cancer while she was still on active duty. Dr. J.H. explained that his opinion is based on the size of the cancer and on the fact that papillary thyroid cancer grows slowly. In a September 2018 letter, private Dr. Y.L. opined that the Veteran probably had papillary thyroid cancer (tumor) undetected many years before the final diagnosis in December 2016. Dr. Y.L. explained that papillary thyroid cancer is usually a slow growing tumor that has relatively long duration until a diagnosis is established. As private doctors M.W., J.H, and Y.L. explained the reasons for their conclusions based on an accurate characterization of the evidence of record and general medical principles, their opinions are entitled to significant probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). With respect to Dr. M.W and Dr. Y.L. opinions, although both "possible" and "probably" terminology was used, to the extent that this did not meet the "at least as likely as not" standard reflected in 38 U.S.C. § 5107(b), it is nevertheless evidence in support of the claim. Cf. Hogan v. Peake, 544 F.3d 1295, 1297-98 (Fed. Cir. 2008) (even if flawed because stated uncertainly, an opinion from a licensed counselor regarding the etiology of a claimant's psychological disorder must be considered as "evidence" of whether the disorder was incurred in service). There is no conflicting medical opinion in the evidence of record. (Continued on the next page) For the foregoing reasons, the current diagnosis, the Veteran's competent and credible lay statements, and private opinions provide a sufficient basis from which to conclude the thyroid cancer had its onset in service. Thus, service connection for thyroid cancer is warranted on a direct basis. As service connection is being granted on a direct basis, consideration of other theories of entitlement is unnecessary. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Walker, 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.