Citation Nr: 22037751 Decision Date: 06/30/22 Archive Date: 06/30/22 DOCKET NO. 16-41 937 DATE: June 30, 2022 REMANDED Entitlement to service connection for a thyroid condition is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1966 to January 1969 and from January 1971 to January 1974, with service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2015 rating decision. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in November 2018. A transcript of that hearing is of record. The Board denied this matter in a July 2019 decision. The Veteran appealed the denial to the United States Court of Appeals for Veterans Claims (Court). In November 2020, the Court issued an order granting a Joint Motion for Remand (JMR), which served to vacate the July 2019 Board denial of service connection for a thyroid condition. The Board remanded this matter for additional development most recently in February 2022. 1. Entitlement to service connection for a thyroid condition is remanded. The claim must be remanded again because the opinion obtained on remand is inadequate. Stegall v. West, 11 Vet. App. 268 (1998). The February 2022 remand instructed the AOJ to obtain an opinion as to whether the Veteran's thyroid condition is related to exposure to herbicide agents in service, and to discuss the connection between herbicide agent exposure and other thyroid conditions, namely that hypothyroidism is presumed to be caused by herbicide agents, an October 2011 VA treatment note indicates that herbicide agent exposure places the Veteran at an increased risk for papillary thyroid cancer, and an October 2013 VA treatment note states that herbicide agent exposure is a potential but not established risk factor for thyroid malignancy. The February 2022 medical opinion found that the Veteran's thyroid condition is less likely than not caused by service with the rationale that previous Agent Orange exposure is not an established primary etiology for thyroid enlargement/thyroid nodule, nor has Agent Orange been associated with an increased risk of papillary thyroid cancer and thyroid malignancy. The clinician did not address the treatment notes to the contrary referenced in the remand instruction, nor did he address the fact that hypothyroidism is presumed to be caused by herbicide agent exposure. Upon remand, a new medical opinion should be obtained that reconciles the examiner's opinion with the evidence of record. Additionally, the Veteran submitted a February 2022 VA Form 10182 as to thyroid condition in which he states that his thyroid condition is secondary to heart disease. This VA Form 10182 is not timely and thus does not allow the Veteran to switch to the AMA system, but the Board does recognize it as a statement by the Veteran raising a new theory of entitlement, which is that his thyroid condition is secondary to service-connected coronary artery disease. This theory of entitlement should also be addressed by the medical opinion obtained upon remand. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding the etiology of the Veteran's thyroid condition. The clinician is asked to provide the following opinions: (a) What is the medical probability that the Veteran's thyroid condition is caused by exposure to herbicide agents in service? The clinician must reconcile their answer with evidence that other thyroid conditions are considered related to exposure to herbicide agents specifically, the October 18, 2011 VA treatment note stating that Agent Orange exposure places the Veteran at increased risk for papillary thyroid cancer; the October 24, 2013 VA treatment note stating that Agent Orange is a potential but not established risk factor for thyroid malignancy; and the fact that hypothyroidism is presumed to be caused by exposure to herbicide agents. (b) What is the medical probability that the Veteran's thyroid condition is at least as likely as not proximately due to or aggravated (defined as any increase in disability) by service-connected coronary artery disease with congestive heart failure? 2. The AOJ must confirm that the VA medical opinion provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Budd, 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.