Citation Nr: 18147796 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 17-62 117 DATE: November 6, 2018 ORDER Entitlement to service connection for neurosarcoidosis is granted. REMANDED Entitlement to service connection for hypothermia is remanded. Entitlement to service connection for detrusor sphincter dyssynergy is remanded. Entitlement to service connection for panhypopituitarism is remanded. FINDING OF FACT The Veteran’s neurosarcoidosis began during active service. CONCLUSION OF LAW The criteria for service connection for neurosarcoidosis have been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from July 1985 to August 1990. These matters are before the Board of Veterans’ Appeals (Board) on appeal from A rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). 1. Service connection for neurosarcoidosis Service connection may be established for disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (2018). Service connection may be granted for any disease initially diagnosed after discharge, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d) (2018). For chronic diseases listed in 38 C.F.R. § 3.309(a), including sarcoidosis, the linkage element of service connection may also be established by demonstrating continuity of symptoms since service. 38 C.F.R. § 3.303(b) (2018); see Walker v. Shinseki, 708 F.3d 1331 (Fed.Cir.2013). 38 C.F.R. § 3.307(a)(3) provides for presumptive service connection for chronic diseases that become manifest to a degree of 10 percent or more within one year from the date of separation from service. The Veteran contends that his neurosarcoidosis was incurred during active service. He has reported that during service he experienced visual impairment, which was subsequently attributed to his neurosarcoidosis. A March 1991 private treatment record reveals the Veteran’s history of visual loss in the left eye for “several months.” The record indicates that the neuro-ophthalmologic examination revealed “historical data suggestive of optic neuropathy with changes in color vision and decreased intensity.” A June 1997 correspondence from Dr. J. B., indicates that he evaluated the Veteran in 1990 for symptoms and signs of optic neuropathy, which were later determined to be manifestations of sarcoidosis. Additionally, in a March 2017 opinion, a VA examiner stated that the Veteran’s optic neuropathy was a manifestation of his neurosarcoidosis. After consideration of the record, the Board finds service connection is warranted for neurosarcoidosis. The record reveals treatment for a manifestation of the neurosarcoidosis within a year of separation from service, notably optic neuropathy, and the Veteran has competently reported that the symptoms attributed to his optic neuropathy began during service. Accordingly, resolving all doubt in the Veteran’s favor, the Board finds the neurosarcoidosis was incurred during active service. REASONS FOR REMAND The claims for service connection for (1) hypothermia, (2) detrusor sphincter dyssynergy, and (3) panhypopituitarism are remanded. The Veteran asserts that his hypothermia, detrusor sphincter dyssynergy, and panhypopituitarism are either manifestation of, or secondary to, his now service-connected neurosarcoidosis. The Board finds the record is unclear as to whether the claimed conditions are symptoms of the neurosarcoidosis or distinct disorders. Accordingly, the Board finds the record would benefit if medical information were obtained for clarification purposes. Additionally, as the record indicates that the Veteran receives ongoing VA treatment, any updated VA treatment records should be obtained on remand. The matters are REMANDED for the following actions: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated him for his claimed disabilities. After securing any necessary releases, the AOJ should request any relevant records identified. In addition, obtain updated VA treatment records. If any requested records are unavailable, the Veteran should be notified of such. 2. After the above is completed to the extent possible, forward the claims file to an appropriate VA clinician to obtain opinions regarding the Veteran's hypothermia, detrusor sphincter dyssynergy, and panhypopituitarism. If an examination is deemed necessary to respond to the questions presented, one should be scheduled. Following review of the claims file, the clinician should opine: (a.) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s hypothermia, detrusor sphincter dyssynergy, and panhypopituitarism are manifestation or symptom of his service-connected neurosarcoidosis or are distinct disorders. (b.) If the Veteran’s hypothermia, detrusor sphincter dyssynergy, or panhypopituitarism are distinct disorders, state whether it is at least as likely as not (50 percent probability or greater) that each distinct disorder is caused by the Veteran’s service-connected neurosarcoidosis? (c.) If the Veteran’s hypothermia, detrusor sphincter dyssynergy, or panhypopituitarism are distinct disorders and are not caused by his service-connected neurosarcoidosis, is it at least as likely as not that each distinct disorder is worsened beyond natural progression (aggravated) by his service-connected neurosarcoidosis? If the clinician finds that the Veteran's hypothermia, detrusor sphincter dyssynergy, or panhypopituitarism was aggravated by his service-connected neurosarcoidosis, the clinician should attempt to quantify the level of aggravation beyond the baseline level of the condition. A complete rationale should be provided for all opinions and conclusions expressed. J. A. Anderson Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N. Snyder, counsel