Citation Nr: 22018148 Decision Date: 03/28/22 Archive Date: 03/28/22 DOCKET NO. 17-41 541 DATE: March 28, 2022 ORDER Entitlement to service connection for Grave's disease, status post radioactive iodine, with hypothyroidism, is granted. FINDING OF FACT The evidence is at least in relative equipoise as to whether the Veteran's Grave's disease had its onset within one-year period following his discharge from service. CONCLUSION OF LAW The criteria for entitlement to service connection for Grave's disease have been met. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.102, 3.303, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1985 to November 1989. This appeal to the Board of Veteran's Appeals (Board) arose from a July 2013 rating decision by the Department of Veteran Affairs (VA) Regional Office (RO). In August 2021, the Board remanded this appeal for further evidentiary development. Service connection for Grave's disease The Veteran seeks service connection for Grave's disease, first claimed as a thyroid condition. He asserts that he began experiencing symptoms within one year of his service dischargeand that he was diagnosed with Grave's disease in 1991, at a Kaiser Permanente medical facility. See August 2017 VA Form 9 (Substantive Appeal). Evidence of record confirms a current diagnosis of Grave's disease. Service connection requires evidence that an injury or disease results in a current disability was incurred during service or was aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. §3.303(a). The evidence must show (1) a current disability; (2) an in-service injury or event; and (3) a nexus between the current disability and the in-service injury or event. 38 C.F.R. §3.303(a). Grave's disease is considered an endocrinopathy, which is a chronic disease listed in 38 C.F.R. §3.309(a). Service connection can be granted for chronic disabilities, if the evidence establishes that it manifested to a compensable degree within one year after the Veteran was separated from service. 38 C.F.R. §3.307, §3.309. Service connection for chronic disabilities can be established with a showing of continuity of symptoms since service, as an alternative to the nexus requirement. 38 C.F.R. §3.303(b). The Board previously remanded this claim to obtain private medical records, to include from Kaiser, as it pertains to the diagnosis and treatment of the Veteran's thyroid condition. Kaiser responded that the facility did not have medical records from the time period provided by the Veteran. See October 2021 Medical Treatment Record Non-Government Facility. Medical records submitted by Kaiser show treatment from 1996, for conditions not germane to this appeal. Id. In a January 2006 medical correspondence from another private medical provider, the physician stated that the Veteran had Grave's disease since 1991 and that he was diagnosed due to hyperhidrosis, weight loss, palpitations, tremor and all other classic signs and symptoms of Grave's disease. See November 2021 Medical Treatment Record Non-Government Facility. This physician has been treating the Veteran for the condition since January 2006, based on a referral. See Id; see also December 2012 Medical Treatment Record Non-Government Facility. In December 2021, the VA examiner opined that it was less likely than not that the Veteran's condition was related to his service. The examiner noted that the October 1989 separation examination was silent for thyroid disease and that his endocrine system was normal. The examiner acknowledged the January 2006 medical letter indicating a 1991 diagnosis of Grave's disease but concluded that the service medical records were silent for symptoms of thyroid disease and that the post-service records indicate a diagnosis of a thyroid condition established more than one year after service. The Board notes that the lack of in-service documentation is not an absolute bar to service connection. Buchanan v. Nicholson, 451 F.3d 1331, 1337 (2006). As stated above, because the Veteran's condition is considered chronic, service connection can still be warranted if the evidence supports that the condition had its onset within one year of service separation. Although there are no Kaiser medical records noting that reported diagnosis in 1991, the records obtained show that he was receiving treatment at Kaiser in the 1990's. As previously noted herein, the Veteran and his treating physician state that he was diagnosed with Grave's disease in 1991 due to associating symptoms. Regarding the doctor noting the 1991 diagnosis, it is not clear if his treating physicians reviewed those medical records regarding the initial diagnosis or if that was information relayed by the Veteran. Even if the statement was relayed to the doctor by the Veteran without a review of the Kaiser medical records, the Board finds the statement pertaining to the 1991 diagnosis to be credible. See Fed. R. Evid. 803(4) (noting that statements made to physicians for the purposes of diagnosis and treatment are exceptionally trustworthy and not excluded by the hearsay rule because the declarant has a strong motive to tell the truth in order to receive proper care); Rucker v. Brown, 10 Vet. App. 67, 73 (1997) ("[R]ecourse to the [Federal] Rules [of Evidence] is appropriate where they will assist in the articulation of the Board's reasons")). Furthermore, considering the initial diagnosis of Grave's disease to be in 1991, it is reasonable that, as the Veteran asserts, symptoms of his condition began in 1990, within one year of his 1989 separation from service. Based on the current evidence of the record, the Board finds that the evidence is at least in relative equipoise regarding whether the Veteran's Grave's disease was related to his service. The Board acknowledges that the evidence in this case is not explicitly clear in resolving the issue regarding the specific onset of the Veteran's condition. Significant time has been used to develop the evidentiary record in this matter in order to resolve the uncertainties. However, those uncertainties have not been resolved. Based on Kaiser's response, another remand would cause further delay in this matter, without resolving those uncertainties. Considering what has been proffered in the medical records, in addition to statements made by the Veteran and his treating physician, there is enough competent evidence to raise a reasonable doubt regarding the onset of the Veteran's Grave's disease. Resolving reasonable doubt in favor of the Veteran, the Board finds that a nexus has been established. Accordingly, the Board finds that the criteria for service connection for Grave's disease, status post radioactive iodine, with hypothyroidism, have been met and that entitlement to service connection for this disorder is warranted. THERESA M. CATINO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Middleton, Syesa T. 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.