Citation Nr: 18159940 Decision Date: 12/21/18 Archive Date: 12/20/18 DOCKET NO. 17-23 073 DATE: December 21, 2018 ORDER Entitlement to service connection for liver disease due to service-connected sarcoidosis is granted. REMANDED Entitlement to service connection for a kidney disability due to service-connected sarcoidosis is remanded. FINDING OF FACT The Veteran’s liver disease has been shown to be caused by his service-connected sarcoidosis. CONCLUSION OF LAW The criteria for service connection for liver disease due to service-connected sarcoidosis have been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1956 to August 1959. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2015 rating decision. On his April 2017 VA Form 9, the Veteran indicated he was only appealing the issues of entitlement to service connection for a liver disability due to sarcoidosis and entitlement to service connection for a kidney disability due to sarcoidosis. Entitlement to service connection for liver disease due to service-connected sarcoidosis is granted. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge when all the evidence establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). Certain chronic diseases, although not shown in service, may be presumed to have incurred in or aggravated by service if they become manifested to a compensable degree within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. To prevail on the issue of service connection, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of an in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). A disability can be service connected on a secondary basis if it is proximately due to or the result of a service-connected condition. 38 C.F.R. § 3.310(a). Moreover, secondary service connection may be established, as well, by any increase in severity (i.e., aggravation) of a nonservice-connected condition that is proximately due to or the result of a service-connected condition. See 38 C.F.R. § 3.310 (b); see also Allen v. Brown, 7 Vet. App. 439, 448 (1995). Where a service-connected disability aggravates a nonservice-connected condition, a Veteran may be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. Allen, 7 Vet. App. at 448. In short, in order to establish entitlement to service connection on this secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) probative evidence establishing a nexus (i.e., link) between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). The determination of whether the requirements of service connection have been met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). In making these determinations, the Board must consider and assess the credibility and weight of all evidence in the claim file, including the medical and lay evidence, to determine its probative value. In doing so, the Board must provide its reasoning for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Barr v. Nicholson, 21 Vet. App. 303 (2007). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. A claimant need only demonstrate an approximate balance of positive and negative evidence in order to prevail. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). For a claim to be denied on the merits, a preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996). As noted above, the first element of secondary service connection requires evidence of a current disability. The Veteran’s VA treatment records, dated February 2013, show he has current diagnosis of liver disease. Therefore, he has satisfied the first element. The second element of secondary service connection requires evidence of a service-connected disability. Here, as noted in a January 2006 rating decision, the Veteran is currently service-connected for pulmonary sarcoidosis. Thus, the Veteran has satisfied the second element of secondary service connection for his liver disease claim. As previously mentioned, the third element of secondary service connection requires evidence of a medical nexus establishing a connection between the service-connected disability and the current disorder. In February 2013, the Veteran received a liver consultation. It was noted the Veteran had stage 3 pulmonary sarcoidosis. It was also noted the Veteran had abnormal liver function. The examiner noted the “most likely etiology, given the mild, persistent elevations and the lack of progression and negative workup for other causes, is sarcoidosis involving the liver.” Indeed, a review of the Veteran’s service connection history shows his sarcoidosis has affected other areas of the body. The Board acknowledges the VA opinion of record dated October 2014, which states that no current liver disability is present. However, even if the Board were to find this opinion probative, the evidence would at least be in equipoise, and the February 2013 VA treatment record referencing liver disease establishes a current disability, regardless of whether it subsequently resolved. McClain v. Nicholson, 21 Vet. App. 319 (2007). Under such circumstances, reasonable doubt must be resolved in favor of the Veteran and entitlement to service connection for liver disease due to service-connected sarcoidosis is warranted. REASONS FOR REMAND Entitlement to service connection for a kidney disability due to service-connected sarcoidosis is remanded. The Board has reviewed the Veteran’s October 2014 kidney examination; however, a new examination is warranted as that examination did not conduct or review any imaging studies of the Veteran’s kidney. The Board determines that given the nature of the Veteran’s service-connected sarcoidosis, as it appears to have spread or manifested into other parts of his body, a new examination is warranted to conduct appropriate testing to determine whether his service-connected sarcoidosis is affecting his kidneys. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records (to include from the Martinsburg VA Medical Center, Washington D.C. VA Medical Center; and the VA Hagerstown Community Based Outpatient Clinic) and private medical records identified by the Veteran as pertinent to his claims. If the RO cannot locate such records, it must specifically document the attempts that were made to locate them and explain in writing why further attempts to locate or obtain any records would be futile. The RO must then: (a.) Notify the claimant of the specific records that it is unable to obtain; (b.) Explain the efforts VA has made to obtain that evidence; and (c.) Describe any further action it will take with respect to the claim. The Veteran must then be given an opportunity to respond. 2. Obtain a VA examination and opinion for the Veteran’s kidney disease. The claims file and a copy of this Remand must be made available to and reviewed by the examiner in conjunction with the opinion. Ultrasound or other appropriate imaging of the kidney should be completed, or the examiner should explain why such imaging is not necessary to provide the requested opinions. The examiner should then address the following: (a.) The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any current kidney disease had its clinical onset during active service or is related to any in service disease, event, or injury. (b.) The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) any current kidney disease was caused by the Veteran’s service-connected sarcoidosis or whether his service-connected sarcoidosis is affecting his kidneys. (c.) The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) any current kidney disease was aggravated (i.e., worsened) by the Veteran’s service-connected sarcoidosis. The examiner must provide a comprehensive report that includes a complete rationale for all opinions and conclusions reached. Shamil Patel Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Denton, Buck