HYPOTHYROIDISM

K. PARAKKAL · 2026 · Case ID: A26040755

MIXED

Summary

The veteran, who served from October 1963 to October 1967, including combat service in the Republic of Vietnam, appeals the denial of an initial compensable evaluation for hypothyroidism. The Board reviewed VA examinations from August 2024 and July 2025, which found no current signs or symptoms attributable to a thyroid condition, despite the veteran's reported fatigue, cold intolerance, and bowel issues. The Board found the VA examinations more probative than the veteran's hearing testimony, noting the veteran's lay statements were not competent to identify the nature or etiology of his symptoms. The Board also noted that the six-month period for a 30 percent rating for hypothyroidism without myxedema had long passed, and no residuals of the condition or related eye/digestive disorders were present. Consequently, the Board found the evidence persuasively against a compensable evaluation for hypothyroidism, denying the claim. The case also involves a remand for lumbar degenerative disc disease and a bilateral foot condition. The Board found a duty to assist error in the prior decision's failure to obtain examinations for these conditions, given the veteran's combat status and occupational specialties, and the evidence of current symptoms and imaging findings. The case is remanded for new VA examinations to determine the nature and etiology of the lumbar degenerative disc disease and the foot condition, and to assess the likelihood of service connection.

Rationale

VA examinations found no signs or symptoms attributable to thyroid condition.; Veteran's lay testimony regarding fatigue and cold intolerance not as probative as medical evidence.; Six-month evaluation period for 30% rating expired long ago; no residuals or related disorders present.

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

7903

Docket No.

251106-593120

Full Decision Text

Citation Nr: A26040755
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 251106-593120
DATE: April 30, 2026

ORDER

Entitlement to an initial compensable evaluation for hypothyroidism is denied.

REMANDED

Service connection for lumbar degenerative disc disease (claimed as back condition) is remanded.

Service connection for bilateral foot condition is remanded.

FINDING OF FACT

The competent and probative evidence is persuasively against finding that the Veteran's hypothyroidism was manifested by myxedema or any other residuals during the period on appeal.

CONCLUSION OF LAW

The criteria for entitlement to an initial compensable evaluation for hypothyroidism have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.119, Diagnostic Code 7903.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active duty service from October 1963 to October 1967, with combat service in the Republic of Vietnam.

The matters come to the Board of Veterans' Appeals (Board) on appeal from a September 2025 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).

In the November 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD), the Veteran elected the Hearing option. The Veteran testified before the Board on January 14, 2026. A copy of the hearing transcript is associated with the claims file.

Under the Hearing option, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his or her representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a).

This case has been advanced on the docket pursuant to 38 C.F.R. § 20.902(c).

Increased Ratings

Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Separate ratings can be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007).

In evaluating a disability, the Board considers the current examination reports in light of the entire record to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). 38 C.F.R. §§ 4.1, 4.2, 4.10. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Reasonable doubt regarding the degree of disability will be resolved in the veteran's favor. 38 C.F.R. § 4.3.

1. Entitlement to an initial compensable evaluation for hypothyroidism

The Veteran contends that he is entitled to a compensable evaluation for hypothyroidism.

The Veteran's hypothyroidism is currently evaluated as noncompensable under Diagnostic Code 7903. Diagnostic Code 7903 provides a 100 percent rating for hypothyroidism manifesting as myxedema (cold intolerance, muscular weakness, cardiovascular involvement (including, but not limited to hypotension, bradycardia, and pericardial effusion), and mental disturbance (including, but not limited to dementia, slowing of thought and depression)). 38 C.F.R. § 4.119. This evaluation shall continue for six months beyond the date that an examining
able evaluation for hypothyroidism

The Veteran contends that he is entitled to a compensable evaluation for hypothyroidism.

A 30 percent rating is assigned for hypothyroidism without myxedema. 38 C.F.R. 4.119. This evaluation shall continue for six months after initial diagnosis. Id. Thereafter, rate residuals of disease or medical treatment under the most appropriate diagnostic code(s) under the appropriate body system (e.g., eye, digestive, mental disorders). Id. If eye involvement, such as exophthalmos, corneal ulcer, blurred vision, or diplopia, is also present due to thyroid disease, also separately evaluate under the appropriate diagnostic code(s) in § 4.79, Schedule of Ratings Eye (such as diplopia (DC 6090) or impairment of central visual acuity (DCs 6061-6066)). Id.

In every case where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31.

After careful review of the evidence, the Board finds that a compensable evaluation is not warranted.

Turning to the evidence of record, the Veteran was afforded a VA examination in August 2024. The examiner opined that the Veteran did not have any findings, signs, or symptoms attributable to a thyroid or parathyroid condition. Examination findings included normal eyes and neck, regular pulse, and normal deep tendon reflexes. During the examination, the Veteran reported that hypothyroidism was an incidental finding during a well checkup in 2006. The Veteran was started on medication and has been compliant. The Veteran was prescribed Synthroid 50 mcg at the time of the examination. Laboratory testing in August 2024 revealed elevated TSH and normal Free T4 and Free T3.

The Veteran underwent a second VA examination in July 2025. The Veteran reported that he continues with Synthroid 50 mcg and follows up with his primary care provider every 12 months for routine laboratory monitoring. The Veteran asserted that his condition has progressed/worsened since onset in 2006. This examiner also found that the Veteran did not have any findings, signs, or symptoms attributable to a thyroid or parathyroid condition. Physical examination revealed normal eyes and neck, regular pulse, and normal deep tendon reflexes. Laboratory testing from June 2025 revealed normal TSH and normal Free T4. Laboratory testing in July 2025 showed normal Free T3.

During his January 2026 Board hearing, the Veteran testified that he has fatigue, cold intolerance, constipation, and bowel issues due to hypothyroidism. The Veteran further noted that some of the medicine he takes causes constipation. The Veteran indicated that it takes him a while to go to the bathroom, and it does not seem like he completely clears himself out. He stated that he is always cold and he has times when he falls asleep during the day because he is always tired.

VA treatment records from April 2024 note no abdominal pain, nausea, vomiting, constipation, diarrhea, chills, heat/cold intolerance, focal weakness, loss of sensation, or vision changes. A review of systems in June 2025 revealed pupils equal, round, reactive to light and accomodation with extra-ocular movements intact. Abdominal exam demonstrated a soft, non-tender, non-distended abdomen with good bowel sounds. VA treatment records throughout the period on appeal show no complaints of constipation, bowel issues, or cold intolerance. In July 2025, the Veteran was referred to mental health for symptoms of drinking and fatigue. During the initial evaluation, the Veteran reported that he started drinking when he was 16 and was drinking all day on
pain, nausea, vomiting, constipation, diarrhea, chills, heat/cold intolerance, focal weakness, loss of sensation, or vision changes. A review of systems in June 2025 revealed pupils equal, round, reactive to light and accomodation with extra-ocular movements intact. Abdominal exam demonstrated a soft, non-tender, non-distended abdomen with good bowel sounds. VA treatment records throughout the period on appeal show no complaints of constipation, bowel issues, or cold intolerance. In July 2025, the Veteran was referred to mental health for symptoms of drinking and fatigue. During the initial evaluation, the Veteran reported that he started drinking when he was 16 and was drinking all day on a daily basis. There are no other reports or complaints of fatigue.

The Board finds the August 2024 and July 2025 VA examinations most probative as they are supported by in-person examination, review of relevant medical records, consideration of lay evidence, and medical literature. While the Veteran is competent to report symptoms and experiences observable by his senses, he is not competent to identify or offer an opinion regarding the nature, etiology, or severity of any such symptoms or experiences. Layno v. Brown, 6 Vet. App. 465, 469 (1994). In that regard, the Board has afforded the Veteran's lay statements made for treatment purposes throughout the period on appeal and during the August 2024 and July 2025 VA examinations more probative value than his January 2026 hearing testimony.

Moreover, while the Board may consider evidence received within an applicable evidentiary window in the adjudication of a claim under the AMA, including the Veteran's hearing testimony, it may not remand a claim to correct a pre-decisional duty to assist error based exclusively on evidence received after the AOJ decision on appeal. See 38?C.F.R. §§ 20.302(a); 20.802(a). In that regard, the Board finds no evidence of a pre-decisional duty to assist error warranting remand.

In light of the foregoing, the Board finds that the competent and probative evidence is against finding that the Veteran's hypothyroidism manifested as myxedema or any other residuals at any time during the period on appeal. The Board further finds that a 30 percent evaluation for hypothyroidism without myxedema for six months after initial diagnosis is not warranted. The Veteran's six-month evaluation period following his initial diagnosis would have ended in late 2006 or early 2007, many years prior to the period on appeal. Additionally, there are no discernable and related digestive or eye disorders. The Veteran is service connected for posttraumatic stress disorder (PTSD) directly related to his combat service in the Republic of Vietnam. Symptoms of depression, anxiety, chronic sleep impairment, mild memory loss, suspiciousness, disturbances of mood and motivation, and obsessional rituals which interfere with routine activities are compensated under the rating for PTSD. Under the anti-pyramiding provision of 38 C.F.R. § 4.14, the evaluation of the "same disability" or the "same manifestation" under various diagnoses is to be avoided.

Accordingly, the evidence is persuasively against a compensable evaluation. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable, and the claim for an initial compensable evaluation for hypothyroidism is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

REASONS FOR REMAND

1. Service connection for lumbar degenerative disc disease (claimed as back condition) is remanded.

2. Service connection for bilateral foot condition is remanded.

The Board is not able to make a fully informed decision regarding the issue of service connection for lumbar degenerative disc disease and bilateral foot condition.

The Veteran asserts that he hurt his back and feet due to the rigors of service. Military personnel records verify that the Veteran served as a flames gunner, ammo carrier, and rocket gunner during his combat service in the Republic of Vietnam.

In the September 2025 rating decision on appeal, the AOJ favorably found a current diagnosis of lumbar degenerative disc disease. The AOJ found no current diagnosed disability for bilateral foot condition. However, during an August 2024 peripheral nerves condition, the Veteran reported insidious onset and worse symptoms of the bilateral feet with associated sharp pain to bilateral feet that feels like a jolt. The August 2024 examination demonstrated decreased sensation to light touch at the right foot. In addition, right foot imaging from November 2024 revealed subtle metatarsophalangeal joint and mild to moderate variable
served as a flames gunner, ammo carrier, and rocket gunner during his combat service in the Republic of Vietnam.

In the September 2025 rating decision on appeal, the AOJ favorably found a current diagnosis of lumbar degenerative disc disease. The AOJ found no current diagnosed disability for bilateral foot condition. However, during an August 2024 peripheral nerves condition, the Veteran reported insidious onset and worse symptoms of the bilateral feet with associated sharp pain to bilateral feet that feels like a jolt. The August 2024 examination demonstrated decreased sensation to light touch at the right foot. In addition, right foot imaging from November 2024 revealed subtle metatarsophalangeal joint and mild to moderate variable interphalangeal joint arthropathy; mild to moderate degenerative changes in the right midfoot and ankle; anterior talar beaking; and mild plantar calcaneal enthesopathy.

The Board finds that remand is warranted to correct a pre-decisional duty to assist error. The medical evidence of current disabilities (including pain that may cause functional limitation) and the circumstances, conditions, and hardships of the Veteran's combat status and military occupational specialties during service satisfy the standards of McLendon v. Nicholson, 20 Vet. App. 79 (2006) and the AOJ was required to obtain an examination. The Board recognizes that in cases where a Veteran asserts service connection for injuries or disease incurred or aggravated in combat, 38 U.S.C. § 1154(b) and its implementing regulation, 38 C.F.R. § 3.304(d), are applicable. If the Veteran was engaged in combat with the enemy, VA accepts as sufficient proof of service connection satisfactory lay or other evidence of service incurrence, if the lay or other evidence is consistent with the circumstances, conditions, or hardships of such service. 38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(d). Resolving all doubt in the Veteran's favor, the AOJ's failure to obtain examinations constitutes a pre-decisional duty to assist error and remand is warranted.

The matters are REMANDED for the following action:

1. Schedule the Veteran for an examination to determine the nature and etiology of lumbar degenerative disc disease. The examiner should review the claims file and address the following:

(a.) Whether it is at least as likely as not (an approximate balance of positive and negative evidence, i.e., nearly equal probability) that the Veteran's lumbar degenerative disc disease manifested during active service or is otherwise related to an in-service injury, event, or disease.

The examiner is advised that the Veteran is competent to report in-service events, his symptoms and history. Such reports must be specifically acknowledged and considered in formulating any opinions. Lay statements of record cannot be disregarded solely due to lack of contemporaneous medical evidence.

The examiner must provide a complete rationale for any opinion expressed based on their clinical and medical expertise, established medical principles, and references to the evidence of record, as appropriate.

2. Schedule the Veteran for an examination to determine the nature and etiology of any right and/or left foot condition. The examiner should review the claims file and address the following:

(a.) Whether it is at least as likely as not (an approximate balance of positive and negative evidence, i.e., nearly equal probability) that the Veteran's has a right and/or left foot condition manifested during active service or is otherwise related to an in-service injury, event, or disease.

The examiner is reminded that pain can constitute a current disability, even without an underlying diagnosis, if it causes sufficient functional impairment.

K. Parakkal

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board B Jackson, M.

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.

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