Citation Nr: 18140237 Decision Date: 10/02/18 Archive Date: 10/02/18 DOCKET NO. 13-17 780 DATE: October 2, 2018 REMANDED ISSUES The claim of entitlement to service connection for a low back disorder is remanded. The claim of entitlement to service connection for an acquired psychiatric disorder, diagnosed as depression, is remanded. The claim of entitlement to a compensable rating for pulmonary sarcoidosis is remanded. REMAND The Veteran served on active duty in the United States Coast Guard from October 1970 to February 1977. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2010 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran presented sworn testimony at a hearing before the undersigned in July 2015. The issues above were denied by the Board in an August 2017 decision. The Veteran appealed. In a May 2018 Amended Joint Motion for Remand (JMR), the parties agreed to a remand of all the issues, finding that the February 2016 VA examinations and opinions upon which the Board based its determination were inadequate. As such, the August 2017 Board decision was vacated and the claims remanded for further action consistent with the terms of the JMR. In accordance with the terms of the May 2018 JMR, the matters are REMANDED for the following action: 1. Obtain all outstanding VA medical records and ask the Veteran to provide authorizations for any private medical records he would like considered in his appeal. 2. Obtain an addendum opinion from a qualified examiner addressing the onset and etiology of the Veteran’s major depressive and low back disorders, the severity of the Veteran’s service-connected pulmonary sarcoidosis, and the extent to which the Veteran’s current symptoms are due to pulmonary sarcoidosis (or the residuals thereof) rather than chronic obstructive pulmonary disease (COPD) or any other nonservice-connected disability. An examination is not required unless deemed so by the examiner. Depression The examiner should state whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s diagnosed major depressive is (1) caused at least in part or (2) aggravated by his service-connected pulmonary sarcoidosis. In reaching his or her conclusions, the VA examiner should specifically review and consider the Veteran’s reports at the July 2015 Board hearing that his sarcoidosis contributed to his depression. See Hr.’g Tr. at 15. The examiner is advised that the term “aggravation” is defined for legal purposes as a chronic worsening of the underlying condition versus a temporary flare-up of symptoms, beyond its natural progression. If aggravation is present, the clinician should indicate, to the extent possible, the approximate level of disability (i.e., a baseline) before the onset of the aggravation. Low Back The examiner should state whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s low back disorder (1) had its onset in service or (2) is related to an event, injury or disease incurred in service. In reaching his or her conclusions, the VA examiner should specifically review and consider the Veteran’s reports at the July 2015 Board hearing that his low back pain began in service and has continued since that time. See Hr.’g Tr. at 18-20, 44. The examiner should NOT rely on the absence of medical records or evidence of medical treatment post service as the sole rationale for any negative medical nexus opinion without explaining the medical significance of the absence of such treatment. Pulmonary Sarcoidosis 3. The examiner should provide a full description of the Veteran’s pulmonary disability and report all signs and symptoms necessary for evaluating his disability under the rating criteria. For each symptom found to be present, the examiner should state whether it is at least as likely as not (50 percent or greater probability) that the symptom is due to the Veteran’s service-connected pulmonary sarcoidosis (or the residuals thereof). If the examiner determines that the Veteran does not have sarcoidosis, or the residuals thereof, the examiner should address the notation in the November 2012 VA examination report that the Veteran was diagnosed with sarcoidosis in October 2010. If any opinion requested above cannot be rendered without resorting to speculation, the examiner should state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Tracie N. Wesner, Counsel