Citation Nr: 25008917 Decision Date: 07/08/25 Archive Date: 07/08/25 DOCKET NO. 16-19 637A DATE: July 8, 2025 ORDER The claim for service connection for thyroid cancer or residuals thereof is granted. The claim for service connection for hypothyroidism is granted. The claim for service connection for angioedema is granted. The claim for service connection for parathyroid adenoma (also claimed as hypoparathyroid) is granted. The claim for service connection for a seizure disorder is granted. The claim for service connection for obstructive sleep apnea is granted. The claim for service connection for hypertension is granted. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran's favor, her thyroid cancer or residuals thereof are at least as likely as not related to service. 2. The Veteran's hypothyroidism is due to service-connected thyroid cancer residuals. 3. The Veteran's angioedema is due to service-connected thyroid cancer or residuals thereof. 4. The Veteran's parathyroid adenoma (also claimed as hypoparathyroid) is due to service-connected thyroid cancer or residuals thereof. 5. The Veteran's seizure disorder is due to service-connected thyroid cancer or residuals thereof. 6. The Veteran's obstructive sleep apnea is due to service-connected thyroid cancer or residuals thereof. 7. The Veteran's hypertension is due to service-connected obstructive sleep apnea. CONCLUSIONS OF LAW 1. The criteria for service connection for thyroid cancer or residuals thereof are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for hypothyroidism as secondary to thyroid cancer or residuals thereof are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 3. The criteria for service connection for angioedema as secondary to thyroid cancer or residuals thereof are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 4. The criteria for service connection for parathyroid adenoma as secondary to thyroid cancer or residuals thereof are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 5. The criteria for service connection for a seizure disorder as secondary to thyroid cancer or residuals thereof are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 6. The criteria for service connection for obstructive sleep apnea as secondary to thyroid cancer or residuals thereof are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 7. The criteria for service connection for hypertension as secondary to obstructive sleep apnea are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 2003 to November 2005. The claims listed above were remanded by the Board of Veterans' Appeals most recently in April 2022. In August 2022 correspondence, the Veteran withdrew the claims of service connection for thyroid cancer, hypothyroidism, seizure disorder, angioedema, and parathyroid adenoma pursuant to 38 U.S.C. § 1151. The Veteran continues to pursue these claims on a direct or secondary service connection basis. Service Connection 1. The claim for service connection for thyroid cancer or residuals thereof The Veteran was first diagnosed with thyroid cancer in 2012 and underwent lobectomies in July 2012 (on the right) and April 2013 (on the left) at a VA medical facility. She has contended that her thyroid cancer should be service connected on the basis of the chronic disease presumption provided in 38 C.F.R. §§ 3.307 and 3.309, as her medical records show that she developed a right thyroid nodule in 2006, less than one year after she was discharged from active duty. She argues this nodule was potentially malignant and the source of her cancer diagnosed six years later. VA has attempted to obtain a medical opinion addressing whether the thyroid nodule identified in 2006 reflected the onset of a malignant growth, or thyroid cancer. Notably, a December 2019 VA examination report indicated that the nodule identified in 2006 was initially thought to be benign but that six years later the same nodule was found to have grown and was later determined to be malignant. A November 2021 VA opinion merely noted there was no objective evidence that showed that the nodule was malignant in 2006 as there were no records of a biopsy confirming diagnosis until 2012. The chronic disease presumption holds that certain diseases, including malignant tumors, which manifest within one year of separation from service will be considered service connected. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Accordingly, if the nodule identified in 2006 is found to be a precursor of malignant growth, service connection would seem to be warranted. The Board finds that based on the evidence already of record and based on the fact that this appeal has already been remanded several times (partially in an attempt to obtain adequate VA examinations and medical opinions), the Board finds that another attempt to remand for a VA examination and medical opinion would be futile. Upon review of the record, the Board finds the lay and medical evidence to at least be in equipoise as to whether the Veteran's thyroid nodule noted in 2006 was malignant. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for thyroid cancer or residuals thereof is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The claim is granted. 2. The claim for service connection for hypothyroidism The Veteran contends that her hypothyroidism is a result of the removal of her thyroid gland due to thyroid cancer. The November 2021 VA examination shows the Veteran has a current disability of hypothyroidism, and the November 2021 VA examiner opined that it is at least as likely as not due to or the result of the service-connected residuals of thyroid cancer. The examiner noted the Veteran was first diagnosed with thyroid cancer in 2012 and underwent lobectomies in July 2012 and April 2013. Due to the removal of the thyroid the Veteran developed hypothyroidism. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current hypothyroidism is due to the service-connected thyroid cancer or residuals thereof. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for hypothyroidism is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. The claim for service connection for angioedema The Veteran contends that her angioedema is a result of the removal of her thyroid gland due to thyroid cancer. VA treatment records show the Veteran has a current disability of angioedema, and she first experienced angioedema shortly after the removal of her thyroid. There has been no other cause shown for the development of her angioedema. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current angioedema is due to the service-connected thyroid cancer or residuals thereof. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for angioedema is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 4. The claim for service connection for parathyroid adenoma (also claimed as hypoparathyroid) The Veteran contends that her hypoparathyroidism is a result of the removal of her thyroid gland due to thyroid cancer. A January 2017 VA treatment record noted the Veteran had hypocalcemia mostly secondary to iatrogenic hypoparathyroidism. Iatrogenic hypoparathyroidism results from surgical damage of the parathyroid glands. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current hypoparathyroidism is due to the service-connected thyroid cancer or residuals thereof. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for hypoparathyroidism is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 5. The claim for service connection for a seizure disorder The Veteran contends that her seizures are a result of the removal of her thyroid gland due to thyroid cancer. The May 2016 VA examination shows the Veteran has a current disability of seizures. A January 2017 VA treatment record noted the Veteran had seizures in the past and was told they were due to hypocalcemia. The assessment was hypocalcemia mostly secondary to iatrogenic hypoparathyroidism. Iatrogenic hypoparathyroidism results from surgical damage of the parathyroid glands. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current seizure disorder is due to the service-connected hypoparathyroidism which is a residual of the service-connected thyroid cancer. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a seizure disorder is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 6. The claim for service connection for obstructive sleep apnea (OSA) A March 2021 VA opinion stated it was much more likely that the Veteran's OSA was due to obesity causing obstruction. In situations when a patient is of normal weight and other risk factors are ruled out, then correlation with psychiatric conditions or upper airway problems could possibly be made, however, in this case the most obvious risk factor was the Veteran's extremely high weight. In a November 2021 VA opinion, an examiner opined there was no medical evidence showing the Veteran's obesity had been aggravated beyond normal progression by her service-connected conditions. The examiner further noted that her obesity was affected by her not having a thyroid gland and poor diet. As there is an indication the Veteran's OSA is impacted by her obesity, that her obesity may be caused, at least in part, to her lack of a thyroid gland, and the issue of service connection for residuals of thyroid cancer has been granted herein, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current OSA is due to the service-connected thyroid cancer or residuals thereof. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for OSA is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 7. The claim for service connection for hypertension The Veteran contends that her hypertension is a result of her OSA. In a December 2019 VA opinion, the examiner opined that the Veteran's hypertension was caused by OSA, not aggravated by it. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current hypertension is due to the service-connected OSA. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for hypertension is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. MARJORIE A. AUER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Gastoukian, Kelly 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.