Citation Nr: 22018504 Decision Date: 03/29/22 Archive Date: 03/29/22 DOCKET NO. 14-35 211A DATE: March 29, 2022 ORDER An effective date prior to August 22, 2011 for the grant of service connection for an acquired psychiatric disorder is denied. An effective date prior to June 21, 2010 for the grant of service connection for residual hypothyroidism, status-post Grave's disease, is denied. Prior to December 12, 2019, a rating in excess of 30 percent for acquired psychiatric disorder is denied. From December 12, 2018, a rating in excess of 50 percent for acquired psychiatric disorder is denied. A rating in excess of 30 percent for residual hypothyroidism, status-post Grave's disease, is denied. FINDINGS OF FACT 1. The Veteran's initial claim for service connection for an acquired psychiatric disorder was received on August 22, 2011; the Veteran was granted service connection for an acquired psychiatric disorder effective August 22, 2011. 2. The Veteran's initial claim for service connection for residual hypothyroidism, status-post Grave's disease, was received on June 21, 2010; the Veteran was granted service connection for residual hypothyroidism, status post Grave's disease, effective June 21, 2010. 3. Prior to December 12, 2019, the Veteran's acquired psychiatric disorder more nearly approximated symptoms of the type and extent, frequency, and/or severity (as appropriate) that are indicative of no more than occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. 4. From December 12, 2019, the Veteran's acquired psychiatric disorder has been manifested more nearly approximated symptoms of the type and extent, frequency, and/or severity (as appropriate) that are indicative of occupational and social impairment with reduced reliability and productivity due to such symptoms as: a flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and, difficulty in establishing and maintaining effective work and social relationships. 5. From March 1, 2011, the Veteran's residual hypothyroidism, status-post Grave's disease, does not more nearly approximated by hypothyroidism with myxedema. CONCLUSIONS OF LAW 1. The criteria for an effective date earlier than August 22, 2011, for the grant of service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 5103, 5103A, 5110; 38 C.F.R. § 3.400 2. The criteria for an earlier effective date for the grant of service connection for residual hypothyroidism, status post Grave's disease, have not been met. 38 U.S.C. §§ 5103, 5103A, 5110; 38 C.F.R. § 3.400. 3. Prior to December 12, 2019, the criteria for a rating in excess of 30 percent for an acquired psychiatric disorder, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9435. 4. From December 12, 2019, the criteria for a rating in excess of 50 percent for an acquired psychiatric disorder, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9435. 5. From March 1, 2011, the criteria for a rating in excess of 30 percent for residual hypothyroidism, status-post Grave's disease, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.119, Diagnostic Code 7903. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active-duty service from May 1990 to July 1992. Applicable to the instant issues on appeal, the Board denied the above-captioned issues in a March 2021 decision. In pertinent part, the Board found that the weight of competent and probative evidence did not support the benefits which the Veteran sought on appeal. The Veteran appealed the March 2021 Board decision to the United States Court of Appeals for Veteran's Claims (Court), which resulted in an October 2021 Joint Motion for Partial Remand (JMR). The parties to the JMPR found that the Board erred by issuing its March 2021 decision before the Veteran's January 12, 2021 Privacy Act request had been processed. As such, the Board did not adhere to the provisions of 38 C.F.R. § 20.1200 and the parties found that remand was warranted. Tucker v. West, 11 Vet. App. 369, 374 (1998). EARLIER EFFECTIVE DATES The Veteran asserts that he is entitled to earlier effective dates for the grants of service connection for an acquired psychiatric disorder and residual hypothyroidism, status-post Grave's disease Except as otherwise provided, the effective date of an evaluation and award of compensation based on an original claim or a claim reopened after final disallowance, will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 C.F.R. § 3.400. The effective date of an award of service connection shall be the day following the date of discharge or release if application is received within one year from such date of discharge or release. Otherwise, the effective date is the date of receipt of claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400 (b)(2)(i). Prior to March 24, 2015, VA recognized formal and informal claims. A claim is defined as a formal or informal communication in writing requesting a determination of entitlement, or evidencing a belief in entitlement, to a benefit. 38 C.F.R. § 3.1(p). An informal claim is any communication or action indicating intent to apply for one or more benefits and must identify the benefit sought. 38 C.F.R. § 3.155 (a). VA must look to all communications from a claimant that may be interpreted as applications or claims both formal and informal for benefits and is required to identify and act on informal claims for benefits. Servello v. Derwinski, 3 Vet. App. 196, 198 (1992). Although a claimant need not identify the benefit sought "with specificity," see Servello v. Derwinski, 3 Vet. App. 196, 199-200 (1992), some intent on the part of the Veteran to seek benefits must be demonstrated. See Brannon v. West, 12 Vet. App. 32, 34-35 (1998). VA must perform a sympathetic reading to all pro se pleadings of record. Szemraj v. Principi, 357 F. 3d 1370, 1373 (Fed. Cir. 2004). In deciding this case based on its application of the law to the pertinent facts, the Board notes that the "date of receipt" of claim means the date on which the claim was received by VA, except as to specific provisions for claims received in the State Department, the Social Security Administration, or the Department of Defense. 38 C.F.R. § 3.1(r). Acquired psychiatric disorder Specifically, the Veteran contends in his September 2019 NOD that he is entitled to an effective date of June 21, 2010 the date he filed his service connection claim for "Gulf War Syndrome/Grave's disease" because in support of this claim, he had submitted numerous statements which showed he endorsed anger and described noticeable behavioral changes since service. Upon review of the record, the Board finds that there is no basis to grant an effective date prior to August 22, 2011, for the award of service connection for an acquired psychiatric disorder. The law is clear that the effective date for an original claim for service connection is the date of receipt of the claim or the date entitlement arose, whichever is later. Here, the Veteran filed an initial claim for service connection for posttraumatic stress disorder (PTSD) that was received by VA on August 22, 2011. As such, the date of receipt of claim is August 22, 2011. Thus, even assuming that entitlement to service connection for an acquired psychiatric disorder arose prior to that date, the earliest possible effective date of a grant of service connection for an acquired psychiatric disorder would be the date the initial service connection claim was received August 22, 2011. Contrary to the Veteran's contentions, the record does not establish that he made an "informal" claim for an acquired psychiatric disorder on June 21, 2010. In the various filings the VA received from the Veteran on the date of June 21, 2010, the Veteran made clear that he was requesting service-connection for Gulf War Syndrome/Grave's disease, and that he was also seeking an increased rating for his service-connected lumbar strain. He did not make a claim of any type of acquired psychological disorder at that time. The Board acknowledges the lay statements and buddy statements that note the Veteran had anger and irritability problems, but the Board finds that the evidence does not establish an etiological relationship, or nexus, between the Veteran's acquired psychological disorder and his service until the April 30, 2014 examination report by a private licensed clinical psychologist that gave a diagnosis of PTSD and opined that the Veteran developed PTSD in response to his time in the military. As the weight of competent and probative evidence is against this claim, the benefit of the doubt rule is not applicable. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). An effective date earlier than August 22, 2011 for service connection for an acquired psychiatric disorder is not warranted. Service connection for residual hypothyroidism, status-post Grave's disease In his September 2019 NOD, the Veteran did not indicate what date should be assigned for service connection. Upon review of the record, the Board finds that there is no basis to grant an effective date prior to June 21, 2010, for the award of service connection for an acquired psychiatric disorder. The law is clear that the effective date for an original claim for service connection is the date of receipt of the claim or the date entitlement arose, whichever is later. Here, the Veteran filed an initial claim for service connection for Grave's disease that was received by VA on June 21, 2010. As such, the date of receipt of claim is June 21, 2010. Thus, even assuming that entitlement to service connection for residuals of Grave's disease arose prior to that date, the earliest possible effective date of a grant of service connection for residuals of Grave's disease would be the date the initial service connection claim was receivedon June 21, 2010. As for the date entitlement arose, the Board notes that the evidence does not establish an etiological relationship between the Veteran's residuals of Grave's disease and his service until the November 16, 2017 examination report by a private physician who opined that the Veteran's diagnosis of Grave's disease with subsequent hypothyroidism, as well as his other symptoms, to include tremor, headaches, exhaustion, cognitive dysfunction, rashes, arthralgias and myalgias, and diarrhea were a textbook description of "Gulf War Syndrome." As articulated above, the law provides that the effective date of a claim will be the date of receipt of the claim or the date entitlement arose, whichever is the later. In this case, the Veteran filed his claim on June 21, 2010, and the date entitlement arose was November 16, 2017 the date of the private exam that provided a nexus between the Veteran's residual hypothyroidism status post Grave's disease and his service. As such, there is no evidence or argument to support an effective date for the grant of service connection prior to June 21, 2010. This is the earliest effective date possible based upon the facts in this case and the law and regulations. An effective date earlier than June 21, 2010 for service connection for residual hypothyroidism status-post Grave's disease is not warranted. As the weight of competent and probative evidence is against this claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. 49. INCREASED RATINGS The Veteran asserts that the respective ratings assigned to his service-connected disabilities, as captioned above, do not reflect the severity of the respective disability (during the time frame under consideration). Ratings for service-connected disabilities are determined by comparing the Veteran's symptoms with criteria listed in VA's Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. Separate Diagnostic Codes identify the various disabilities. 38 C.F.R. Part 4. When rating a service-connected disability, the entire history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. 38 C.F.R. § 4.7. The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Hart v. Mansfield, 21 Vet. App. 505 (2007). Pyramiding, the rating of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a veteran's service-connected disabilities. 38 C.F.R. § 4.14. It is possible for a Veteran to have separate and distinct manifestations from the same injury which would permit rating under several Diagnostic Codes; however, the critical element in permitting the assignment of several ratings under various Diagnostic Codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). Acquired psychiatric disorder Under the General Rating Formula for Mental Disorders, a 30 percent rating is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care and conversation normal), due to such symptoms as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, and recent events). A 50 percent evaluation will be assigned with evidence of occupational and social impairment with reduced reliability and productivity due to such symptoms as: a flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood, due to such symptoms as: suicidal ideations; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of the veteran's personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. A 100 percent rating is warranted for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform the activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation or own name. When determining the appropriate disability evaluation to assign, the Board's primary consideration is the Veteran's symptoms, but it must also make findings as to how those symptoms impact the Veteran's occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F. 3d 112, 118 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). When adjudicating psychiatric claims, the Board has an obligation under Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017) to conduct a three-part "holistic" analysis. The first step of the analysis is to assess the "severity, frequency, and duration of the signs and symptoms" of the Veteran's condition. The second step is to quantify "the level of occupational and social impairment caused by those signs and symptoms." The third step is to assign an "evaluation that most closely approximates that level of occupational and social impairment." See also Mauerhan, 16 Vet. App. 436 (holding that the list of symptoms in the disability rating schedule for psychiatric disabilities is not exhaustive); and see Vazquez-Claudio, 713 F. 3d 112 (holding that the disability rating schedule for psychiatric disabilities reflects "objectively-observable symptomatology," and "it is the severity of the effects of the symptoms as described by the examiner that determines the rating."). As all ratings in the general rating formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the Veteran's impairment must be "due to" those symptoms, a veteran may only qualify for a given disability by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. See Vazquez-Claudio, 713 F. 3d 112. Evidence and Analysis In September 2011, The Veteran reported for a VA psychiatric examination. A psychologist reviewed the claims file; considered the Veteran's lay accounts of his medical history; and conducted an appropriate evaluation (hereinafter "VA exam protocols"). The psychologist indicated that the Veteran did not have a current diagnosis of PTSD, but he did have a diagnosis of "mood disorder due to general medical condition (Grave's disease and thyroidectomy)." The psychologist did not diagnosis any other mental health disorder. The psychologist noted the Veteran's symptoms included chronic sleep impairment, flattened effect, and disturbances of motivation and mood. The psychologist reported that, at that time, the Veteran conveyed that he had been with his wife for the last 16 years; that they have been married for six years; and that they have a five-year-old child. The Veteran relayed that he has a good relationship with his wife, but he gets angry at times, yelling and screaming, which scares the child. The Veteran indicated that he liked the Army but was discharged medically for back problems. For the last 13 years, the Veteran worked for cable company; he also conveyed that he worked in the security industry for a few years. Also, the Veteran indicated that he had been counseled at his workplace for a poor attitude (grumpiness, negative, and angry). The clinician opined that the Veteran's acquired psychiatric disorder was productive of occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. In April 2014, a private clinician evaluated the Veteran's mental health status. The clinician provided diagnoses of posttraumatic stress disorder (PTSD) and unspecified depression. This clinician reported that the Veteran stated he had been deployed to Iraq during the Gulf War and had been a member of a long-range reconnaissance team. Moreover, the Veteran conveyed that his team has the responsibility of retrieving enemy corpses and body parts; and burying such in mass graves. Also, the Veteran reported that on three occasions he evaded near death. When asked the clinician inquired as to the impact of service, the Veteran conveyed that he has continuous nightmares. Moreover, the Veteran reported that his spouse told him that he talked, thrashed about, and became violent during sleep cycles. The Veteran indicated that regularly checked the locks on doors and windows, peering outside for any possible intruders or imminent dangers. In public places, the Veteran maintained vigilance and awareness of people in his environment. In short, the Veteran conveyed that he never really felt completely safe. The Veteran also watched people to ascertain whether they were carrying firearms. The clinician indicated that the Veteran conveyed that he was not motivated or driven to do anything, and he had poor memory and concentration skills. The Veteran denied auditory or visual hallucinations. The clinician opined that the Veteran was married and had a 7-year-old son. Lastly, the clinician noted that the Veteran reported difficulty and irritability (which he usually concealed his from his coworkers and his supervisors). While the Board assigns a slight measure of probative weight to this clinician's opinion, such weight is minimal. It remains unclear from whence the clinician derived the two mental health diagnoses (as such were not put into play in the body of this report). Moreover, this report contains much in the way of lay reporting, but little in the way of clinical findings. And, it remains unclear whether the clinician performed a studious review of the claims file, to ascertain whether evidence corroborated lay accounts. Sklar v. Brown, 5 Vet. App, 140 (2003 In December 2019, the Veteran underwent another VA psychiatric examination. The psychologist followed VA exam protocols, The psychologist provided current diagnoses of current (1) Other Specified Mental Disorder Due to Another Medical Condition; and (2) Other Specified Trauma and Stressor-Related Disorder. Nevertheless, the psychologist noted examiner significant overlap and interdependence of symptoms such that differentiating what symptoms are related to each diagnosis could not be performed without resorting to mere speculation. The Veteran's symptoms included depressed mood; anxiety; suspiciousness; chronic sleep impairment; flattened affect; disturbances of motivation and mood; and impaired impulse control, such as unprovoked irritability with periods of violence. Speech was normal in volume, rate and prosody. There was some increased psychomotor activity. The Veteran's eye contact was poor-to-fair; his mood appeared depressed and anxious; and his affect appeared generally restricted. There was neither evidence of hallucinations nor delusional thoughts. Likewise, there was evidence of thought disorder, obsession, or compulsions. The psychologist opined that insight was fair and judgment appeared adequate. However, the Veteran's memory and concentration appeared mildly impaired, as secondary to mood and anxiety. The Veteran denied current suicidal or homicidal ideations, plans, or intents. The psychologist indicated that the Veteran acquired psychiatric disorder was productive of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. A review of VA treatment record discloses that clinicians followed the status of the Veteran's mental health throughout the period under consideration. Clinician provided therapy services and monitored the efficacy of the Veteran's prescription roster. In a February 2015 letter, a Vet Center readjustment counseling therapist wrote that the Veteran completed the intake process in November 2014, adding that the Veteran received a diagnosis of PTSD, The therapist also wrote that the severity of the Veteran's PTSD would require on-going care for the foreseeable future. In March 2015, the Veteran submitted a lay statement. In pertinent part, the Veteran relayed that anger and depression had worsened, beginning after service. Whereas, prior to service, the Veteran asserted that had many friends, and an active social life. This same month, the Veteran's spouse, mother-in-law, and a military comrade submitted lay accounts, which collectively reported the Veteran's anger and depression. The Veteran's spouse added that the Veteran suffered daily from a host of ailments and symptoms, to include knee pain; back pain, headaches; odd rashes; anger which can escalate into uncontrollable rage; insomnia; exhaustion; diarrhea; shaking extremities; and current memory problems. The Board finds that the currently assigned 30 percent disability rating prior to December 12, 2019, and 50 percent rating thereafter adequately contemplate the severity of the Veteran acquired psychiatric disorder. Prior to December 12, 2019, the Veteran's symptoms did not more nearly approximate occupational and social impairment with reduced reliability and productivity. Indeed, the Veteran reported continuing to maintain a good relationship with his wife and son and maintained long-term employment. Bankhead, 29 Vet. App. 10. Although the Veteran endorsed chronic sleep impairment, flattened effect, and disturbances of motivation and mood, there was no psycho-medical evidence showing impaired judgment, thinking, difficulty establishing and maintaining relationship. Notably, as articulated above, the September 2011 VA psychologist found the Veteran's symptomatology to be mild and, at most, productive of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. This level of symptomatology corresponds to no more than the 30 percent rating currently assigned prior to December 12, 2019. From December 12, 2019, the Board finds that the medical evidence of record fails to disclose that the Veteran exhibited symptoms of the type, extent, frequency, or severity indicative of those identified as warranting a 70 percent ratingsuicidal ideations; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of the veteran's personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. Here too, the Veteran has consistently maintained a relationship with his wife and son and remained gainfully employed. Bankhead, 29 Vet. App. 10. (As such, there were not notable deficiencies in the Veteran's familial relationships. Moreover, the clinical and lay evidence of evidence of record fail to approximate near-continuous panic or depression or that he has demonstrated impairment of judgment or thinking. The Veteran does not endorse suicidal or homicidal ideation, Quite to the contrary, the December 2019 VA psychologist specifically opined that the Veteran did not endorse these ideations. This VA psychologist indicated that that the Veteran's symptomatology was productive of no more than occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. Consequently, the Board finds that the level of severity of the Veteran's psychiatric symptoms do not more nearly approximate those contemplated by a 70 percent rating from December 12, 2019. The Board is aware that the presence or absence of specific symptoms, which correspond to a particular rating, is not dispositive. 38 C.F.R. § 4.130; Mauerhan, 16 Vet. App. 436. Nevertheless, as articulated above, the evidence does not show that the Veteran's symptomatology manifested as more severe than that contemplated by a 30 percent rating assigned prior to December 12, 2019, or manifests in symptomatology more severe that that that contemplated by the 50 percent rating assigned from December 12, 2019. The Board has also considered the lay statements from the Veteran and the Veteran's family members. Lay persons are competent to provide opinions on some medical issues. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). However, in this case, such an opinion falls outside the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (Fed. Cir. 2007). While lay parties are competent to discernable symptoms, they are not competent to provide competent psycho-medical opinion as to the clinical severity of the Veteran's acquired psychiatric disorder. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009). Therefore, the Board concludes that the weight of probative and competent evidence is against the claims for a rating in excess of 30 percent for an acquired psychiatric disorder prior to December 12, 2019, and in excess of 50 percent thereafter. As such, there are no doubts to resolve. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 49. A rating in excess of 30 percent for residual hypothyroidism, status post Grave's disease. Under Diagnostic Code 7903, a maximum 100 percent rating is assigned for hypothyroidism with 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)). Note 1 following the 100 percent rating states: This rating is to continue for 6 months beyond the date 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) (e.g., eye, digestive, and mental disorders). A 30 percent rating is assigned for hypothyroidism without myxedema. Note 2 following the 30 percent rating states: This rating is to continue for 6 months after initial diagnosis. Thereafter, rate residuals of disease or medical treatment under the most appropriate Diagnostic Code(s) under the appropriate body system (e.g., eye, digestive, mental disorders). Note 3 following the 30 percent rating states: If eye involvement, such as exophthalmos, corneal ulcer, blurred vision, or diplopia, is also present due to thyroid disease, also separately evaluate under the appropriate Diagnostic Code(s) in §4.79, Schedule of Ratings Eye (such as diplopia (DC 6090) or impairment of central visual acuity (Diagnostic Codes 6061-6066)). Evidence and Analysis In a June 2010 private treatment record, a clinician from M. reported that the Veteran's primary symptoms consisted of heat intolerance, irritability, some loose stools, and fairly marked tremors. This clinician did not report any heart palpitations or weight loss. The clinician did indicate some dyspnea on exertion. Thyroid blood tests revealed that TSH was 0.02, and that total T4 was 19.1 (normal range is 4.5 to 12.0). A thyroid scan showed a homogeneous bilateral uptake, although the right upper lobe did appear to be "somewhat" hypofunctioning. The clinician indicated that the Veteran requested radioactive iodine therapy. In July 2010, the M. clinician opined that the Veteran reported he felt about the same, although the Veteran thought that his heat intolerance and tremors had improved. In September 2010, the M. clinician reported that the Veteran had Grave's disease and underwent ablation. After ablation, the Veteran reported that he felt much improved, although not quite back to normal. Clinically, the Veteran's tremors had resolved; the Veteran had gained some weight; and the Veteran endorsed that he felt better "overall". In January 2011, the Veteran reported for a VA general examination. The clinician followed VA exam protocols. The clinician indicate a past diagnosis of Grave's disease (June 2010), which manifested in symptoms of heat intolerance; irritability; loose stools; marked tremors with no palpitations; and weight changes. The Veteran's TSH was 0.2 (with increased total T4). Upon review of the file, a thyroid scan revealed homogeneous bilateral uptake with somewhat hypofunctioning right upper lobe. The Veteran had taken 25 milligrams of atenolol four times a day (q.d.), but he had terminated use of the pharmaceutical agent. As noted above, the M. clinician reported hyperthyroidism and recommended a treatment regime of radioactive iodine in 2010. Upon the instant physical examination, the Veteran denied any neck symptoms; endorsed shortness of breath with moderate exertion; and denied cough, wheezing, dizziness, syncope, fever, or weight loss. The Veteran conveyed that he experienced fatigue, which he attributed to his insomnia. Based upon examination findings and the Veteran's reports, the clinician rendered a revised current diagnosis of history of Grave's disease, status-post radiation with residual hypothyroidism. In A November 2017 private evaluation report, a clinician noted that the Veteran's diagnosis of Grave's disease with subsequent hypothyroidism, as well as his other symptoms, to include tremor, headaches, exhaustion, cognitive dysfunction, rashes, arthralgias and myalgias, and diarrhea were a textbook description of "Gulf War Syndrome." While the Board assigns some probative weight to this clinician's opinion, such weight is minimal. It remains unclear from whence the clinician derived her "textbook" conclusion. Moreover, this report contains little in the way of clinical findings. And, it remains unclear whether the clinician performed a studious review of the claims file, to ascertain whether evidence corroborated her conclusory account. Sklar, 5 Vet. App, 140. In a June 2019 VA treatment record, a clinician ran a physiological systems review. The clinician indicated that the Veteran's endocrine system did not divulge symptoms of polydipsia; heat or cold intolerance; or marked weight changes. In January 2020, the Veteran reported for another VA examination. A clinician performed VA exam protocols. This clinician provided a current diagnosis of status-post Grave's disease with residual hypothyroidism. The clinician reported that the Veteran had undergone radioactive iodine treatment (ablation) in 2011, and was undergoing treatment with Synthroid. The Veteran reported that his status had not changed since his last VA examination. The Veteran also reported that his physician varied his medication dosing (to ensure that such ensured a normal pulse and no reactive symptoms). Upon the instant physical examination, the clinician reported that the Veteran's eyes were normal, and the Veteran's pulse was regular. Consequently, this clinician concluded that the Veteran did not have any current signs or symptoms of a thyroid disorder. From March 1, 2011, no clinician of record found that the Veteran's residual hypothyroidism, status-post Grave's disease manifestations included myxedema, digestive, mental disorders, or eye involvement. Moreover, from March 1, 2011, the evidence of records fails to disclose symptomatology indicative of a 100 percent ratinghypothyroidism with 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 Board assigns significant probative weight to the VA examinations of record. In each instance, an expert reviewed the claims file; considered the Veteran's lay accounts of his medical history; and conducted an appropriate evaluation. Moreover, these experts supported their findings with evidence-based rationales. The January 2020 clinician opined that the Veteran did not have any current signs or symptoms of a thyroid disorder. The Veteran believes that this residual disability was more severe than that contemplated by a 30 percent rating from March 1, 2011. The Board has considered the Veteran's sincere beliefs. While the Veteran is competent to report discernable symptoms and report etiological opinions of competent clinicians (Jandreau, 492 F. 3d 1372; Kahana, 24 Vet. App. 428), the evidence of record fails to disclose that the Veteran has the training or expertise to render opinions as to the clinical severity of an endocrinological disease entity (according to highly specialized evaluative criteria). 38 C.F.R. § 3.159(a)(1). Therefore, the weight of competent and probative evidence is against granting a rating in excess of 30 percent for residual hypothyroidism, status-post Grave's disease from March 1, 2011. As such, there are no doubts to resolve. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 49. James A. DeFrank Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. J. Komins, 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.