Citation Nr: 23020436 Decision Date: 04/04/23 Archive Date: 04/04/23 DOCKET NO. 19-00 494A DATE: April 4, 2023 REMANDED Entitlement to service connection for Grave's disease, to include as a result of exposure to environmental hazards in Southwest Asia/Persian Gulf is remanded. REASONS FOR REMAND The Veteran served on active duty in the Army from March 1978 to June 1995. In August 2019, the Board remanded the Veteran's claim for additional development, but the claim must be remanded again. Entitlement to service connection for Grave's disease, to include as a result of exposure to environmental hazards in Southwest Asia/Persian Gulf. The Veteran asserts that his claimed Grave's disease is directly related to his service in the Persian Gulf War. The Veteran has confirmed service in the Southwest Asia theatre of operations, and is presumed exposed to toxic/environmental hazards. Pub. L. 117-168, § 302 (codified at 38 U.S.C. § 1119). The claim must be remanded again because the October 2019 VA opinion is inadequate. Stegall v. West, 11 Vet. App. 268 (1998). The examiner based the negative opinion, in part, on the fact that Grave's disease is not considered on the list of diseases presumptively related to Gulf War service and the fact that findings related to Grave's disease were not shown closer in time to service. The opinion did not address whether the Grave's disease was directly related to the conceded exposures in service. The opinion on remand must consider the presumed toxic exposure risk activity, Pub. L. 117-168, § 302 (codified at 38 U.S.C. § 1168. The matters are REMANDED for the following action: 1. Obtain an opinion from an appropriate clinician on the likely etiology of the diagnosed Grave's disease. Copies of all pertinent records must be made available to the examiner for review. If the examiner finds that an opinion cannot be provided without an examination, one should be scheduled. The examiner must answer the following: Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the diagnosed hypothyroidism/Grave's disease had its onset during any period of active duty service, or is otherwise etiologically related to the Veteran's service, to include the conceded exposure to toxic/environmental hazards? The examiner must specifically discuss the following: that the Veteran was exposed to environmental hazards, toxic, and fine particulate matters during his Gulf War service, and; must consider the total potential exposure through all applicable military deployments, as well as the synergistic, combined effect of all toxic exposure activities of the Veteran. The examiner is asked to explain the reasons behind any opinions expressed and conclusions reached. The lack of documented treatment in service, or a long period after, while probative, cannot serve as the sole basis for a negative finding. The Veteran's lay contentions must be considered and weighed in making the determination. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resorting to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Carter, 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.