Citation Nr: 22018915 Decision Date: 03/30/22 Archive Date: 03/30/22 DOCKET NO. 19-30 956 DATE: March 30, 2022 ORDER Entitlement to service connection for right upper extremity carpal tunnel syndrome has been withdrawn and dismissed without prejudice. Entitlement to service connection for right upper extremity carpal tunnel syndrome has been withdrawn and dismissed without prejudice. Entitlement to service connection for a thyroid disorder, claimed as hypothyroidism, to include as secondary to an acquired psychiatric disorder, is denied. FINDINGS OF FACT 1. During the Veteran's June 2021 hearing, the Veteran and her representative indicated a desire to withdraw the Veteran's appeal with regard to the issue of service connection for carpal tunnel syndrome in the upper extremities. 2. The Veteran's thyroid disorder was not shown in service or for many years thereafter, and is not otherwise related to active-duty service to include as secondary to an acquired psychiatric disorder. CONCLUSIONS OF LAW 1. The criteria for withdrawal of entitlement to service connection for t carpal tunnel syndrome in the upper extremities have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205. 2. The criteria for entitlement to service connection for a thyroid disorder, claimed as hypothyroidism, to include as secondary to an acquired psychiatric disorder, have not been met. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran has active-duty service from July 1994 to March 1997. The Veteran testified before the undersigned Veteran's Law Judge in June 2021. A transcript of that hearing is of record. 1. Entitlement to service connection for carpal tunnel syndrome in the upper extremities During the Veteran's June 2021 hearing, the Veteran and her representative expressed a desire to withdraw her claims for bilateral carpel tunnel syndrome. Under 38 U.S.C. § 7105, the Board may dismiss any appeal that fails to allege specific error of fact or law in the determination being appealed. An appeal may be withdrawn in writing or during a hearing at any time before the Board promulgates a decision. Withdrawal may be made by the claimant or by his or her authorized representative. 38 C.F.R. § 20.204. The undersigned explained the significance of her withdrawal to the Veteran, and the Veteran acknowledged her understanding. Id.; see also Acree v. O'Rourke, 891 F.3d 1009 (Fed. Cir. 2018), adopting the rule of DeLisio v. Shinseki, 25 Vet. App. 45, 57-58 (2011). As such, the issues are dismissed. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). In addition to the regulations cited above, service connection is warranted for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (2016). Any additional impairment of earning capacity resulting from an already service-connected condition, regardless of whether or not the additional impairment is itself a separate disease or injury caused by the service-connected condition, should also be compensated. Allen v. Brown, 7 Vet. App. 439 (1995). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. Id. 2. Entitlement to service connection for a thyroid disorder The Veteran asserts that her thyroid disorder is related to active-duty service. Specifically, she asserts that her disorder is secondary to her already service connected acquired psychiatric disorder. The Board concludes that, while the Veteran has a current diagnosis of a thyroid disorder, the weight of the evidence is against finding that the Veteran's disorder began during service or are otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. §§ 3.303(a), (d), 3.304, 3.307, 3.309. As an initial matter, with respect to her thyroid disorder, the service treatment records do not report any signs, symptoms, or a diagnosis of this disorder at any point during service. Similarly, while the Veteran had an acute complaint of diarrhea during service due to food poisoning, the service treatment records do not report any chronic symptoms or a diagnosis related to a gastrointestinal disorder. The Board notes that the post-service medical evidence includes some statements to the Veteran's medical providers that she may have had symptoms of these disorders since service. However, the objective medical evidence does not demonstrate any symptoms, manifestations, or a diagnosis related to a thyroid disorder until approximately 2017 nearly 20 years after service. Therefore, continuity of symptoms has not been shown based on the clinical evidence, including for purposes of the chronic disease presumption under 38 C.F.R. § 3.307(a)(3). As part of this claim, the Board recognizes the statements from the Veteran regarding her history of symptoms since service. In this regard, while the Veteran is not competent to make a diagnosis related to this disorder, as it must be diagnosed by its unique and readily identifiable features, and thus requires a determination that is "medical in nature," she is nonetheless competent to testify about the presence of observable symptomatology, which may provide sufficient support for a claim of service connection, if credible, regardless of the lack of contemporaneous medical evidence. Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2007); see Barr v. Nicholson, 21 Vet. App. 303, 307 (2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Nevertheless, the Board determines that the Veteran's reported history of continued symptomatology since active service, while competent, is nonetheless not sufficient to establish continuity of symptomology. As an initial matter, the large gap in treatment for the asserted conditions weighs against the Veteran's claims. Further, the Board notes that the Veteran filed a claim for VA benefits almost 20 years prior to filing the claim on appeal. Therefore, the fact that the Veteran was aware of the VA benefits system and sought out a claim for other benefits, but made no reference to the disorders she now claims is inconsistent with symptoms existing since service. Next, service connection may also be granted when the evidence establishes a medical relationship between active-duty service and current complaints. In this case, the Board gives significant probative weight to the September 2018 VA examination where the examiner opined that the Veteran's thyroid disorder was not related to active-duty service including secondary to an acquired psychiatric disorder. The rationale the Veteran provided was that hypothyroidism is a condition in which your thyroid gland does not produce enough of certain important hormones. There are many possible causes of hypothyroidism including autoimmune disease, certain medications, congenital condition, pituitary disorder, pregnancy, treatment of hyperthyroid condition, thyroid surgery, or history of radiation to the neck. He further stated that the condition was most likely due to the Veteran's age and gender or Hashimoto's disease. Additionally, the Board observes that the Veteran has not provided sufficient evidence, including private opinions and/or medical evidence to establish a nexus between her complaints and active service. Also, the Board acknowledges the medical article that the Veteran submitted. However, the Board places little probative value on the article, as it was not submitted with a supportive medical opinion. In fact, the September 2018 VA examiner noted there is nothing in the article or any research done that relates posttraumatic stress disorder as a cause of hypothyroidism. As part of this claim, the Board recognizes the statements from the Veteran regarding the relationship between her disorder and active service. Nevertheless, while she is competent to provide testimony regarding observable symptomatology such as weight gain and fatigue, she is not competent to provide a nexus opinion in this case. These issues are also medically complex, as it requires knowledge of the interaction between multiple systems in the body and interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Therefore, the unsubstantiated statements regarding the claimed diagnosis and etiology of the Veteran's disorders are found to lack competency. In light of the above discussion, the Board concludes that the weight of the evidence is against her claim for service connection, and there is no doubt to be otherwise resolved. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Therefore, the appeal is denied. 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. B.T. KNOPE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Billinger, Associate Counsel