THYROID ENLARGEMENT TOXIC (GRAVES' DISEASE OR THYROTOXICOSIS)

Summary

The Veteran served from March 1998 to July 1999. This case comes before the Board of Veterans' Appeals (Board) on appeal from a December 2024 higher-level review rating decision concerning hyperthyroidism and a thyroidectomy scar. The Veteran sought an initial compensable rating for hyperthyroidism with bilateral dry eye syndrome and a rating for a thyroidectomy scar. The Board reviewed evidence of record up to the November 2023 AOJ decision, as later-submitted evidence was not considered for this appeal. The Veteran was diagnosed with hyperthyroidism in 2003, and the Board found no evidence of cardiac involvement warranting a separate rating. However, the Board found that the Veteran's bilateral dry eye syndrome, a manifestation of hyperthyroidism, warranted a 20 percent rating by analogy to DC 6025 for bilateral disorders of the lacrimal apparatus, resolving doubt in the Veteran's favor. For the thyroidectomy scar, the Board noted it was located on the anterior neck, measured 14 centimeters long, and had a depressed surface contour. This scar presented two characteristics of disfigurement, warranting a 30 percent rating under DC 7800. Therefore, the Board granted entitlement to an initial 20 percent rating for hyperthyroidism with bilateral dry eye syndrome and a 30 percent rating for the thyroidectomy scar.

Rationale

Hyperthyroidism diagnosed in 2003; Bilateral dry eye syndrome noted by VA examiner; Rated by analogy to DC 6025 for bilateral lacrimal apparatus disorders; Resolving doubt in Veteran's favor

Full Decision Text

Citation Nr: A26029367
Decision Date: 04/01/26	Archive Date: 04/01/26

DOCKET NO. 251124-610286
DATE: April 1, 2026

ORDER

Entitlement to an initial 20 percent rating for hyperthyroidism with bilateral dry eye syndrome is granted.

A separate 30 percent rating for a thyroidectomy scar is granted. 

FINDINGS OF FACT

1. During the entire appeal period, the Veteran's hyperthyroidism has resulted in bilateral dry eye syndrome, which exhibits symptoms comparable to a bilateral disorder of the lacrimal apparatus. 

2. The Veteran's thyroidectomy scar results in two characteristics of disfigurement. 

CONCLUSIONS OF LAW

1. The criteria for entitlement to an initial 20 percent rating for hyperthyroidism with bilateral dry eye syndrome have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.79, 4.119, Diagnostic Code (DC) 7900-6025.

2. The criteria for a 30 percent rating for a thyroidectomy scar have been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, Diagnostic Code (DC) 7800. 

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from March 1998 to July 1999. 

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2024 higher-level review rating decision issued by a Department of Veterans Affairs (VA) Regional Office, which is the Agency of Original Jurisdiction (AOJ). The December 2024 rating decision granted service connection for the Veteran's hyperthyroidism and assigned an initial noncompensable rating.  It was a higher-level review for a November 2023 rating decision. 

In the November 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the November 2023 AOJ decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. Evidence submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review, was not considered by the Board in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Entitlement to an initial compensable rating for hyperthyroidism.

Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity.  Separate DCs identify the various disabilities. 38 U.S.C. §1155; 38 C.F.R. Part 4.  Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized.  38 C.F.R. § 4.1.

Separate ratings can be assigned for separate periods based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. Given the nature of the present claim for a higher initial evaluation, the Board has considered all evidence of severity from the effective date of the award of service connection.  Fenderson v. West, 12 Vet. App. 119 (1999).

Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating.  Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7.  

The Veteran's hyperthyroidism is currently rated as noncompens
 whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. Given the nature of the present claim for a higher initial evaluation, the Board has considered all evidence of severity from the effective date of the award of service connection.  Fenderson v. West, 12 Vet. App. 119 (1999).

Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating.  Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7.  

The Veteran's hyperthyroidism is currently rated as noncompensable under DC 7900-6025. The Veteran's hyperthyroidism is rated under DC 7900, and her manifestation of dry eye syndrome is rated by analogy under DC 6025 for disorders of the lacrimal apparatus. 38 C.F.R. § 4.27.

Under 38 C.F.R. § 4.119, DC 7900, a 30 percent rating for hyperthyroidism, including, but not limited to Graves' disease, is assigned for six months after initial diagnosis.  Thereafter, residuals of the disease or complications of medical treatment are to be rated within the appropriate diagnostic code within the appropriate body system. Pursuant to Note (1), if hyperthyroid cardiovascular or cardiac disease is present, it is to be separately evaluated under DC 7008 (hyperthyroid heart disease). Note (2) provides that eye involvement occurring as a manifestation of Graves' disease be evaluated as diplopia (DC 6090); impairment of central visual acuity (DCs 6061-6066); or under the most appropriate diagnostic codes in 38 C.F.R. § 4.79. 

The Veteran was first diagnosed with hyperthyroidism in 2003. See September 2023 VA Examination. Because the Veteran's hyperthyroidism was not initially diagnosed at any point during the appeal period, a temporary 30 percent rating is not warranted. Further, a review of the medical evidence of record does not show that the Veteran experienced any cardiac disability due to her hyperthyroidism. See e.g., September 2023 VA Examination. Thus, a separate rating under DC 7008 is also not warranted. 

The September 2023 VA examiner found that the Veteran had eye involvement, but no other body system involvement.. Accordingly, the Board will limit its discussion to the evaluation of the Veteran's eye disability as a manifestation of her hyperthyroidism. 

Under 38 C.F.R. § 4.79, DC 6025, a 10 percent disability rating is warranted for unilateral disorders of the lacrimal apparatus (epiphora, dacryocystitis, etc.). A 20 percent disability rating is warranted for bilateral disorders of the lacrimal apparatus (epiphora, dacryocystitis, etc.).  

The Veteran was afforded a VA examination for her eye disability in October 2023. On examination, the examiner did not find a disorder of the lacrimal apparatus but did diagnose the Veteran with dry eye syndrome of the bilateral lacrimal glands. The Veteran reported experiencing symptoms of very dry eyes, pain, and photophobia. The examiner noted that the Veteran treated her condition with Restasis, over the counter artificial tear drops, and gel/lubricating drops. The examiner noted that the Veteran's dry eye syndrome did not cause any decrease in visual acuity or other visual impairment.

Based upon a review of the relevant evidence of record, the Board finds that a 20 percent rating is warranted for the Veteran's bilateral dry eye syndrome. There is no diagnostic code specifically applicable to dry eye syndrome. DC 6025 contemplates eye disabilities involving the lacrimal apparatus. The lacrimal apparatus is defined as "the system concerned with the secretion and circulation of tears and the normal fluid of the conjunctival sac; it consists of the lacrimal gland and ducts, and associated structures." See Dorland's Medical Dictionary (30th Ed. 2003). Although the October 2023 VA examiner did not note a disorder of lacrimal apparatus, the examiner noted that the Veteran used artificial tears to treat her dry eye syndrome. 

Therefore, in light of the Veteran's bilateral dry eye syndrome symptoms, her treatment using artificial tear drops, the definition of "lacrimal apparatus" outlined above, and resolving all reasonable doubt in favor of the Veteran, the Board finds an initial 20 percent rating for bilateral dry eye syndrome is warranted. This is the maximum schedular evaluation permitted under DC 6025. 

The Board has also considered whether a higher evaluation may be warranted under a different DC. However, there is no indication that the
land's Medical Dictionary (30th Ed. 2003). Although the October 2023 VA examiner did not note a disorder of lacrimal apparatus, the examiner noted that the Veteran used artificial tears to treat her dry eye syndrome. 

Therefore, in light of the Veteran's bilateral dry eye syndrome symptoms, her treatment using artificial tear drops, the definition of "lacrimal apparatus" outlined above, and resolving all reasonable doubt in favor of the Veteran, the Board finds an initial 20 percent rating for bilateral dry eye syndrome is warranted. This is the maximum schedular evaluation permitted under DC 6025. 

The Board has also considered whether a higher evaluation may be warranted under a different DC. However, there is no indication that the Veteran experienced any impairment of visual acuity, loss of visual field, or any other compensable impairment of the eyes due to her dry eye syndrome. 38 C.F.R. §4.79. 

Accordingly, entitlement to an initial 20 percent rating for bilateral dry eye syndrome, as a manifestation of hyperthyroidism is warranted. 

The Veteran underwent a thyroidectomy in January 2014. At her September 2023 VA scars examination, it was noted that her scar was located on her anterior neck and was 14 centimeters long and 0.1 centimeters wide.

Diagnostic Code 7800 for the evaluation of burn scar(s) of the head, face or neck; scar(s) of the head, face, or neck due to other causes; or other disfigurement of the head, face, or neck provides that a 10 percent disability rating is assigned when there is one characteristic of disfigurement.  A 30 percent disability rating is warranted when there is visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with two or three characteristics of disfigurement.  A 50 percent disability rating is warranted when there is visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features, or; with four or five characteristics of disfigurement.  An 80 percent disability rating is warranted when there is visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features, or; with six or more characteristics of disfigurement.  See 38 C.F.R. § 4.118, Diagnostic Code 7800.

The eight characteristics of disfigurement are: a scar 5 or more inches (13 or more cm.) in length; a scar at least 1/4 inch (0.6 cm.) wide at widest part; surface contour of scar elevated or depressed on palpation; a scar adherent to underlying tissue; skin hypo- or hyper-pigmented in an area exceeding 6 square inches (39 sq. cm.); skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding 6 square inches (39 sq. cm.); underlying soft tissue missing in an area exceeding 6 square inches (39 sq. cm.); and skin indurated and inflexible in an area exceeding 6 square inches (39  sq. cm.).  Id., Note 1.  

The Veteran's scar is 14 centimeters long. The examiner also found that the surface contour was depressed on palpation. The scar causes two characteristics of disfigurement. Her scar does not meet any of the other characteristics of disfigurement. A separate 30 percent rating for her thyroidectomy scar is warranted under Diagnostic Code 7800. Her scar is not painful. Therefore a separate rating for one painful scar under Diagnostic Code 7804 is not warranted. 38 C.F.R. § 4.118. 

 

 

D. Martz Ames

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	A. Dennis, Associate 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.