Citation Nr: 22047280 Decision Date: 08/19/22 Archive Date: 08/19/22 DOCKET NO. 17-05 893 DATE: August 19, 2022 REMANDED Entitlement to service connection for a thyroid disorder is remanded. INTRODUCTION The Veteran served honorably on active duty in the United States Navy during Peacetime and the Gulf War Era, from November 1982 to November 1994, from August 2001 to November 2001, from December 2002 to June 2004, and from July 2006 to August 2007, including service in the Southwest Asia Theater of Operations during the Persian Gulf War. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2014 Rating Decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. When the matter came before the Board most recently in July 2021, it was denied. The Veteran appealed to the United States Court of Appeals for Veterans Claims (Court) which, pursuant to a Joint Motion for Partial Remand (JMPR), issued its April 2022 Order remanding the matter for action consistent with the terms of the JMPR. Finally, the Board's July 2021 decision remanded the Veteran's service connection claims for a respiratory disorder, sleep disturbances, and headache disorder for additional development. However, as the development has not yet been concluded, these issues are not currently before the Board. REASONS FOR REMAND Entitlement to service connection for a thyroid disorder is remanded. Pursuant to the JMPR, the October 2019 VA examination (report received November 2019) did not comply with the Board's February 2019 remand directives and, therefore, was inadequate for adjudication purposes. See Stegall v. West, 11 Vet. App. 268, 271 (1998); Barr v. Nicholson, 21 Vet. App. 303 (2007). Specifically, although the Board's remand ordered a VA examination to "determine the nature and etiology of any thyroid condition, to include thyroiditis," the examiner only "focused on the thyroglossal duct cyst removal in 1993." Moreover, while the claims file includes evidence of potential hypothyroidism existing prior to 2012, the VA examiner noted "hypothyroidism was first noted in 2012 based on medical records." As a result, the JMPR states that, on remand, the Board must "ensure an adequate VA examiner's opinion is obtained, addressing the ... evidence supporting thyroiditis and treatment for thyroid prior to 2012," consistent with the Board's February 2019 remand directives. Based upon the foregoing, the Board find remand is required to afford the Veteran another VA examination and procure a medical nexus opinion adequate for adjudication purposes. Accordingly, the matter is REMANDED for the following action: Schedule the Veteran for an in-person VA examination with an examiner WHO HAS NOT PREVIOUSLY OFFERED AN OPINION IN THIS MATTER and possessing the necessary expertise to fully assess and render an opinion regarding the nature, severity, and likely etiology of the Veteran's thyroid condition(s). The examiner MUST obtain a full history from the Veteran as he is competent to attest to factual matters of which he has first-hand knowledge, such as observable symptomology and functional limitations. All pertinent symptomology, including when initially manifesting and any continuity over time, MUST be elicited from the Veteran and reported in detail. Any indicated studies MUST be conducted. Based upon review of all pertinent evidence in the claims file (e.g., in-service/post-service medical records, lay statements) and the examination results, the examiner MUST render opinions based upon an accurate medical history, with clear conclusions and supporting data and thorough and soundly reasoned medical explanations connecting the two, as to: (a.) Whether it is AT LEAST AS LIKELY AS NOT (i.e., at least approximately balanced or nearly equal, if not higher) any of the Veteran's thyroid conditions manifested during active duty service OR is due to or otherwise etiologically associated with an in-service event, injury, or illness. (b.) Whether it is AT LEAST AS LIKELY AS NOT (i.e., at least approximately balanced or nearly equal, if not higher) any of the Veteran's thyroid conditions is proximately due to or otherwise etiologically associated with OR aggravated by service-connected anterior neck scar residual from thyroglossal duct cyst removal. In offering the above opinions, the examiner MUST consider, discuss, and reconcile as necessary all pertinent lay and medical evidence of record including, but not limited to, STRs dated June 1993 with pathology report noting benign thyroglossal duct cyst excision; STRs dated January 2009 reporting taking Synthroid in last year; STRs dated April 2012 noting "been on Synthroid for several years following an episode of thyroiditis; and October 2019 VA examination report indicating "[i]n the mid-2000s, he had a work up for fatigue and was diagnosed with hypothyroidism." The examiner is advised the mere absence of objective medical evidence does not automatically equate to unfavorable evidence. Thus, the Veteran's statements and reports of causation, onset, and any continuity of symptomology over time MUST be considered and discussed. A complete and thorough rationale for all opinions expressed, with references to pertinent evidence of record and, as warranted, supportive medical literature MUST be provided. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Worsham, Attorney Advisor 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.