Entitlement to service connection for hypothyroidism as secondary to service connected right hand hyperesthesia with loss of strength and chronic swelling and old healed fracture deformity right third digit is remanded.

Citation Nr: 26001398 Decision Date: 01/30/26 Archive Date: 01/30/26 DOCKET NO. 18-36 849 DATE: January 30, 2026 REMANDED Entitlement to service connection for hypothyroidism as secondary to service connected right hand hyperesthesia with loss of strength and chronic swelling and old healed fracture deformity right third digit is remanded. Entitlement to service connection for a respiratory disorder as secondary to service connected right hand hyperesthesia with loss of strength and chronic swelling and old healed fracture deformity right third digit, service connected right shoulder sprain and/or service connected right elbow sprain is remanded. Entitlement to service connection for a cardiovascular disorder as secondary to service connected right hand hyperesthesia with loss of strength and chronic swelling and old healed fracture deformity right third digit, service connected right shoulder sprain and/or service connected right elbow sprain is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1984 to May 1989. These matters come before the Board of Veterans' Appeals (Board) on appeal from an April 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2020, the Board issued a decision that denied the Veteran's claims for service connection for a thyroid disorder, for a left elbow sprain, for a right foot achilles tendonitis, and for an effective date prior to March 28, 2011, for a right elbow sprain. Additionally, the Board dismissed, without prejudice to refiling, the Veteran's claims for entitlement to revision of January 2004 and January 2005 rating decisions that denied a disability rating in excess of 10 percent for a right-hand disability on the basis of clear and unmistakable error (CUE), and for entitlement to revision of an April 2013 rating decision on the basis of CUE to reflect application of the bilateral factor to disabilities of the upper and lower extremities. The Board remanded the Veteran's claims for service connection for a disorder manifested by chest pain and shortness of breath, as well as for hearing loss for additional development. The Veteran appealed the Board decision to the United States Court of Appeals for Veterans Claims (Court). In a June 2021 Memorandum Decision, the Court vacated the Board's February 2020 decision as to denying service connection for a thyroid disorder, denying an effective date prior to March 28, 2011, for the award of service connection for a right elbow sprain, and dismissing the motions to revise the January 2004, January 2005 and April 2013 rating decisions on the basis of CUE and remanded the matters for adjudication consistent with the Memorandum Decision. The Court affirmed the Board's denial of service connection for a left elbow disorder and right foot Achilles tendinitis. The Court did not disturb the Board's remand of service connection for a disorder manifested by chest pain and shortness of breath, as well as for hearing loss. In April 2022, the Board denied entitlement to revision of the January 2004 rating decision that denied an evaluation in excess of 10 percent for the right-hand disability based on CUE, denied revision of a January 2005 rating decision that denied an evaluation in excess of 10 percent for the right-hand disability based on CUE, and denied an effective date prior to March 28, 2011, for the grant of service connection for a right elbow disability. Also, in April 2022, in accordance with the June 2021 memorandum decision, the Board remanded the issue of whether the bilateral factor under 38 C.F.R. § 4.26 was properly applied in the April 2013 rating decision for the issuance of a statement of the case pursuant to Manlincon v. West, 12 Vet. App. 238 (1999). Moreover, in April 2022, the Board remanded the issues of service connection for a thyroid disorder, service connection for hearing loss, and service connection for chest pain and shortness of breath. The Veteran did not appeal the April 2022 Board decision and it is final. As reflected in October 2022 correspondence, the Veteran was advised that he did not provide the required Appeal to Board of Veterans' Appeals (VA Form 9) to continue his appeal regarding whether the bilateral factor under 38 C.F.R. § 4.26 was properly applied in the April 2013 rating decision. While on remand, in a September 2022 rating decision, an Agency of Original Jurisdiction (AOJ) awarded service connection for hearing loss. As such is a full grant of the benefit sought on appeal with respect to such issue, it is no longer before the Board. Grantham v. Brown, 114 F.3d 1156, 1159 (Fed. Cir. 1997). In May 2024, the Board issued a decision that denied entitlement to service connection for a thyroid disorder and service connection for a disorder manifested by chest pain and shortness of breath. The Veteran appealed the denial decision to the Court. In a May 2025 Memorandum Decision, the Court vacated the Board's May 2024 decision as to the denial of service connection for a thyroid disorder on a secondary basis and service connection for a disorder manifested by chest pain and shortness of breath on a secondary basis and remanded the matters for adjudication consistent with the Memorandum Decision. The Court affirmed the Board's decision denying service connection for chest pain and shortness of breath on a direct basis and under 38 U.S.C. § 1117 and 38 C.F.R. § 3.317. An August 2025 letter informed the Veteran that the Court issued a decision in May 2025 that remanded (sent back) his case to the Board for readjudication, that the Veteran had the opportunity to submit additional argument and/or evidence in support of his appeals before the Board proceeds with readjudication and that the Board will wait to make a decision on his appeal for 90 days from the date of this letter to provide him the opportunity to submit argument and/or evidence. In September 2025, the Veteran submitted a motion that objected to the August 2025 letter, and, as claimed, a fraudulent Court remand. He also asserted CUE. As to his objection to the August 2025 post-mandate letter, in legacy appeals, the Board holds the case for 90 days so that the Veteran has the opportunity to submit additional argument and evidence and/or request an additional hearing. Clark v. O'Rourke, 30 Vet. App. 92 (2018). As to his assertion of a fraudulent Court remand, the Board was unable to determine the nature of his contentions. However, to the extent that he asserts that the Court should have reversed, rather than remanded the May 2024 Board decision, this is outside the Board's purview as it does not have appellate jurisdiction over the Court. Finally, as to CUE, these contentions appear to be related to rating decisions that are not the subject of the issues on appeal. Therefore, the Board shall proceed with adjudication. Relevant to the Veteran's claims of entitlement to service connection for a respiratory disorder and a cardiovascular disorder, such was originally adjudicated by the AOJ as entitlement to service connection for a disorder manifested by chest pain and shortness of breath. However, in Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009), the Court held that, in determining the scope of a claim, the Board must consider the claimant's description of the claim; symptoms described; and the information submitted or developed in support of the claim. In light of the Court's decision in Clemons, the Board has recharacterized the issues on appeal as entitlement to service connection for a respiratory disorder and a cardiovascular disorder. 1. Entitlement to service connection for hypothyroidism as secondary to service connected right hand hyperesthesia with loss of strength and chronic swelling and old healed fracture deformity right third digit is remanded. 2. Entitlement to service connection for a respiratory disorder as secondary to service connected right hand hyperesthesia with loss of strength and chronic swelling and old healed fracture deformity right third digit, service connected right shoulder sprain and/or service connected right elbow sprain is remanded. 3. Entitlement to service connection for a cardiovascular disorder as secondary to service connected right hand hyperesthesia with loss of strength and chronic swelling and old healed fracture deformity right third digit, service connected right shoulder sprain and/or service connected right elbow sprain is remanded. The Veteran contends that his hypothyroidism is due to the use of Gabapentin prescribed for his service connected right hand hyperesthesia with loss of strength and chronic swelling and old healed fracture deformity right third digit. See July 2012 VA examination. He also asserts that his chest pain is secondary to medications taken for his service connected right hand hyperesthesia with loss of strength and chronic swelling and old healed fracture deformity right third digit. See December 2011 Statement in Support of Claim (VA Form 21-4138) submitted in April 2012. The Veteran was afforded VA examinations in December 2023 for his hypothyroidism, respiratory disorder and cardiovascular disorder that was associated with the claims file in January 2024. The examiner opined that it was less likely than not that the Veteran's hypothyroidism was proximately due to or the result of his use of Gabapentin. The rationale provided was that Gabapentin usage has no connection with developing hypothyroidism. Therefore, the examiner concluded that the Veteran's Gabapentin use was unrelated to his hypothyroidism. The examiner also opined that it was less likely than not that the Veteran's hypothyroidism was aggravated beyond its natural progression by his Gabapentin usage. The rationale provided was that the examiner was unable to establish a baseline level of severity as there were insufficient records to do so. The examiner then opined that it was less likely than not that the Veteran's cardiovascular disease was proximately due to or the result of his service connected right shoulder sprain and right elbow sprain. The rationale provided was that cardiovascular disease is of multifactorial etiology. The examiner described the most common risk factors and etiologies and determined that there was not enough evidence to support the Veteran's claim. The examiner also opined that it was less likely than not that the Veteran's cardiovascular disease was aggravated beyond its natural progression by his service connected right shoulder sprain and right elbow sprain. The rationale provided was that the examiner was unable to establish a baseline level of severity as there were insufficient records to do so. Finally, the examiner opined that it was less likely than not that the Veteran's respiratory disorder was proximately due to or the result of his service connected right shoulder sprain and right elbow sprain. The rationale provided was that there was not enough evidence to support the Veteran's claim. The examiner then discussed the common etiologies of the Veteran's respiratory disorder. The examiner also opined that it was less likely than not that the Veteran's respiratory disorder was aggravated beyond its natural progression by his service connected right shoulder sprain and right elbow sprain. The rationale provided was that the examiner was unable to establish a baseline level of severity as there were insufficient records to do so. The Board finds the December 2023 VA medical opinions incomplete to decide the claims. As to service connection for hypothyroidism, the examiner did not address whether the Veteran's Gabapentin was a nonsteroidal anti-inflammatory drug and why nonsteroidal anti-inflammatory drugs contribute to hyperthyroidism but not hypothyroidism as directed in the Board's June 2023 remand directives. As to service connection for a respiratory disorder and cardiovascular disorder, the examiner did not address whether the Veteran's chest pain was due to medication for service connected right shoulder sprain and right elbow sprain as directed in the Board's June 2023 remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). As such, a remand for adequate etiology opinions is required. Where VA provides a veteran with an examination in a claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). On remand, such opinions should be obtained. The matters are REMANDED for the following actions: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and afford him an opportunity to submit any copies in his possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, forward the claims file to an appropriately qualified clinician to determine the etiology of the Veteran's claimed hypothyroidism. The record, to include a copy of this Remand, should be made available to the examiner. The need for further in-person physical examination is left to the discretion of the examiner. The examiner is asked to furnish an opinion with respect to the following question: Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's hypothyroidism was caused and/or aggravated by his service connected right hand hyperesthesia with loss of strength and chronic swelling and old healed fracture deformity right third digit? The examiner should address the Veteran's contention that his hypothyroidism is due to the use of Gabapentin prescribed for his service connected right hand hyperesthesia with loss of strength and chronic swelling and old healed fracture deformity right third digit. The examiner should address whether the Veteran's Gabapentin is a nonsteroidal anti-inflammatory drug and why nonsteroidal anti-inflammatory drugs contribute to hyperthyroidism but not hypothyroidism. If the examiner determines that nonsteroidal anti-inflammatory drugs do not contribute to hypothyroidism and hyperthyroidism, they should explain the discrepancy with the July 2012 VA medical opinion that determined there is a relationship with the use of nonsteroidal anti-inflammatory drugs and hyperthyroidism. A rationale should be provided for all opinions offered. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resorting to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include 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. 3. Following the receipt of outstanding records, forward the claims file to an appropriately qualified clinician to determine the etiology of the Veteran's claimed respiratory disorder. The record, to include a copy of this Remand, should be made available to the examiner. The need for further in-person physical examination is left to the discretion of the examiner. The examiner is asked to furnish an opinion with respect to the following question: Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's respiratory disorder was caused and/or aggravated by his service connected right hand hyperesthesia with loss of strength and chronic swelling and old healed fracture deformity right third digit, right shoulder sprain and/or right elbow sprain? The examiner should address the Veteran's contention that his respiratory disorder is due to the use of medication prescribed for his service connected right hand hyperesthesia with loss of strength and chronic swelling and old healed fracture deformity right third digit, right shoulder sprain and right elbow sprain. A rationale should be provided for all opinions offered. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resorting to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include 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. 4. Following the receipt of outstanding records, forward the claims file to an appropriately qualified clinician to determine the etiology of the Veteran's claimed cardiovascular disorder. The record, to include a copy of this Remand, should be made available to the examiner. The need for further in-person physical examination is left to the discretion of the examiner. The examiner is asked to furnish an opinion with respect to the following question: Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's cardiovascular disorder was caused and/or aggravated by his service connected right hand hyperesthesia with loss of strength and chronic swelling and old healed fracture deformity right third digit, right shoulder sprain and/or right elbow sprain? The examiner should address the Veteran's contention that his cardiovascular disorder is due to the use of medication prescribed for his service connected right hand hyperesthesia with loss of strength and chronic swelling and old healed fracture deformity right third digit, right shoulder sprain and right elbow sprain. A rationale should be provided for all opinions offered. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resorting to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include 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. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Kuhn, 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.