Citation Nr: 18148366 Decision Date: 11/07/18 Archive Date: 11/07/18 DOCKET NO. 11-02 744A DATE: November 7, 2018 REMANDED Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to an initial disability rating exceeding 30 percent for service-connected sarcoidosis including separate, compensable ratings for manifestations of the eyes and pulmonary system is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1979 to February 1982 and from September 1990 to November 1990. The Veteran also served for many years in the Army Reserve including during periods of inactive duty for training and active duty for training. This case comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2008 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2015, the Veteran presented testimony in a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the evidentiary record. The Veteran’s knee claims were remanded by the Board in June 2015 and June 2017 for further development. In the June 2017 decision, the Board granted the Veteran entitlement to service connection for sarcoidosis-related bilateral eye and pulmonary system disabilities. In a March 2018 rating decision, the Agency of Original Jurisdiction (AOJ) granted entitlement to service connection for sarcoidosis with bilateral eye iritis/uveitis, and it assigned a single evaluation of 30 percent under 38 C.F.R. § 4.97, Diagnostic Code 6846. In an April 2018 Notice of Disagreement, the Veteran’s attorney asserted that the Veteran is entitled to higher disability ratings for sarcoidosis including a separate rating for manifestations affecting the Veteran’s eyes consistent with the June 2017 Board decision. The Veteran has raised the intertwined issue of entitlement to TDIU as well. See, e.g., September 2009 Notice of Disagreement. A statement of the case has not yet been issued, and remand is required for the AOJ to issue a statement of the case on these matters. 38 C.F.R. § 20.200; Manlincon v. West, 12 Vet. App. 238, 240-41 (1999). The Board finds that the issue of the severity of the Veteran’s service-connected sarcoidosis is intertwined with the Veteran’s claims for entitlement to service connection for knee disabilities. Recent treatment records show the Veteran has complained of worsening symptoms of sarcoidosis particularly in regard to pulmonary functioning, and an October 2015 opinion from a VA examiner indicates medical literature supports knee pain as a symptom in individuals with sarcoidosis. However, the examiner ultimately indicated that the Veteran did not have a current knee disability despite finding abnormal range of motion in the knees upon examination. The Board finds the opinion to be inadequate as the examiner did not identify an etiology for the abnormal findings or otherwise explain how they are unrelated to the Veteran’s sarcoidosis or reports of knee complaints during his military service. On remand, the AOJ should obtain a new examination addressing the additional evidence and abnormal findings with sufficient rationale.   The matters are REMANDED for the following action: 1. The AOJ should contact the Veteran and all current representatives and request their assistance in identifying any outstanding relevant records. The AOJ should make reasonable attempts to obtain all identified outstanding records and associate them with the Veteran’s claims file. 2. After associating all outstanding records with the Veteran’s claims file, the AOJ should afford the Veteran an examination with an appropriate examiner of the Veteran’s knees. The AOJ should provide the examiner with a complete copy of the claims file to include this remand order. The AOJ should ensure that the examiner follows these directives: (a) The VA examiner should identify all current disabilities associated with the Veteran’s knees. To the extent possible, the examiner should identify the etiology of any abnormal findings on examination such as reduced range of motion, instability, locking, weakness, or reports of pain. (b) For each current disability identified, the examiner should opine whether the disability was at least as likely as not (50 percent or greater probability) caused by the Veteran’s military service to include reports of knee swelling and pain during not only the Veteran’s active duty service but also during periods of active duty for training and inactive duty for training. The examiner should explain why or why not.   (c) For each current disability identified, the examiner should opine whether the disability was at least as likely as not permanently worsened beyond normal progression (aggravated) by the Veteran’s service-connected sarcoidosis. 3. If the examiner is unable to provide an opinion on these matters, the examiner must state whether the inability to render an opinion is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 4. After completing the above action and any other necessary development, the claims must be readjudicated. The AOJ should ensure that a Statement of the Case has been issued for each matter remanded by the Board. If a Statement of the Case already exists on an issue and the claim remains denied, a Supplemental Statement of the Case must be provided to the Veteran and current representatives. After the Veteran has had adequate opportunity to respond, all remaining appealed issues must be returned to the Board for appellate review.   REFERRED In the prior decisions, the Board found the issue of entitlement to service connection for a liver disability had been raised by the record in a July 2010 statement but had not been adjudicated by the AOJ. The Board therefore referred the issue to the AOJ for appropriate action. To date, it does not appear the AOJ has taken action on this issue. Accordingly, the Board again refers it to the AOJ for appropriate action. 38 C.F.R. § 19.9(b) (2017). MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Michael Duffy, Associate Counsel