Citation Nr: 20020482 Decision Date: 03/19/20 Archive Date: 03/19/20 DOCKET NO. 19-29 085 DATE: March 19, 2020 REMANDED Entitlement to an initial disability rating in excess of 10 percent for sarcoidosis is remanded. Entitlement to a total rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran had active military service from October 1966 to October 1968. This matter comes before the Board of Veteran’s Appeals (Board) on appeal from a September 2017 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran raised a claim for entitlement to TDIU based on the severity of his service-connected sarcoidosis, in his September 2018 NOD and September 2019 VA Form I-9, and has submitted medical opinions that suggest he is disabled by this disease. While this matter has not been adjudicated, the Board notes that the TDIU claim is part and parcel with the increased rating issue already on appeal. Rice v. Shinseki, 22 Vet. App. 447 (2009). 1. Entitlement to an initial disability rating in excess of 10 percent for sarcoidosis is remanded. The Veteran contends that his sarcoidosis is more severe than reflected by his current rating. He underwent a VA compensation and pension pulmonary examination to address the severity of this disorder in July 2019, which disclosed pulmonary system findings that did not warrant a rating in excess of 10 percent disabling and found no impact on the Veteran’s ability to work. Since this examination, the Veteran submitted a private medical opinion from a Dr. S. T. dated in December 2019. Dr. S.T. is an internist who reported treating the Veteran for more than 2 years and who opined that the sarcoidosis was aggravating other medical conditions including coronary artery disease (CAD), hypertension, hyperlipidemia and asthma, and indicated that the effects of this precluded the Veteran from securing and maintaining substantial gainful employment. To the extent that this suggests a significant worsening of symptoms since the July 2019 VA examination and the potential existence of extra-pulmonary involvement contemplated by 38 C.F.R. § 4.97, another VA examination should be obtained addressing this opinion. Additionally, the VA treatment records disclose that repeatedly the Veteran was found on optometry examinations to not have ocular manifestations of sarcoidosis, but one record dated in March 2015 indicated he had ocular manifestations of sarcoidosis, contrary to the other examination findings. . Thus, the examination should also address whether he has ocular manifestations of sarcoidosis at any time during the appeal period, and if so, the nature and severity of such manifestations. Additionally, private medical provider, Dr. S.T. alleged treating the Veteran for at least the past 2 years. It is noted that VA treatment records up to August 2019 are of record and do not suggest the symptoms of sarcoidosis to be of the extent suggested by Dr. S.T. The private treatment records from Dr. S.T. could prove significant in adjudicating this matter, should they show more severe symptoms, and an effort should be made to obtain these private records. Likewise, the Veteran has submitted other opinions from private medical providers, including a February 2011 opinion from Dr. A.S. stating that the Veteran is disabled from excessive walking due to sarcoidosis and an opinion from Dr. S. B. dated in July 2018 also reflecting disability due to sarcoidosis. Again, an opportunity to obtain additional private treatment records from these providers to support their opinions should be provided. 2. Entitlement to TDIU is remanded. The Board finds that the claim for TDIU is before the Board as part and parcel of the appeal of the rating for sarcoidosis. See Rice v. Shinseki, 22 Vet. App. 447 (2009). It is inextricably intertwined with his claim on appeal for a higher rating for service-connected sarcoidosis. Therefore, the appropriate remedy where a pending claim is inextricably intertwined with a claim currently on appeal is to remand the claim on appeal pending the adjudication of the inextricably intertwined claim. Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for Dr A.S. located in the Empire Medical Building in Fort Lauderdale, Florida; Dr. S.B. of Family Medical Health/Medical Health Associates in Bellerose, New York; and Dr. S.T. of Family Medical Health/Medical Health Associates in Bellerose, New York. Make two requests for the authorized records from these physicians/facilities unless it is clear after the first request that a second request would be futile. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected sarcoidosis. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria, to include under the appropriate pulmonary criteria and extra-pulmonary criteria to include any ocular manifestations and/or any additional manifestations including those suggested by the December 2019 opinion from Dr. S.T. who opined that the sarcoidosis was aggravating other medical conditions including CAD, hypertension, hyperlipidemia, in addition to asthma. To the extent possible, the examiner should identify any occupational impairment due to his service-connected sarcoidosis and any associated manifestations. Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Carol Eckart 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.