Citation Nr: 21000031 Decision Date: 01/04/21 Archive Date: 01/04/21 DOCKET NO. 17-58 998 DATE: January 4, 2021 REMANDED Service connection for sarcoidosis is remanded. Service connection for sleep apnea is remanded. Service connection for a digestive disorder is remanded. Service connection for dermatitis is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1990 to August 1992. This case is before the Board of Veterans’ Appeals (Board) on appeal from April 2016 and August 2016 Department of Veterans Affairs (VA) Regional Office (RO) rating decision. In a June 2019 decision, the Board denied the Veteran’s claims for service connection for sleep apnea, sarcoidosis, digestive disorder, and dermatitis. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (CAVC or Court). In a May 2020 Court Order granting a Joint Motion for Partial Remand [JMPR], the Court vacated the Board’s June 2019 decision, and remanded the case for further development in compliance with the directives specified in the JMPR. The case is back before the Board at this time in compliance with the May 2020 JMPR and Court order. Regarding the sarcoidosis, the JMPR noted that the Board erred in not considering whether the Veteran’s sarcoidosis was a “medically unexplained chronic multisymptom illness” under 38 C.F.R. § 3.317(a)(2)(i)(B). In this regard, VA obtained a June 2016 VA examination and medical opinion that indicated that the Veteran had pulmonary sarcoidosis with extrapulmonary involvement of the liver. The examiner noted that both pulmonary sarcoidosis and extrapulmonary hepatic sarcoid were “diagnosable chronic multisymptom illnesses with partially explained etiologies.” However, in the medical opinion, the examiner found that the Veteran’s sarcoidosis was less likely as not related to military service, because “the etiology of sarcoidosis was not definitively known.” The doctor further stated that, due to cited medical literature, there was inadequate/insufficient evidence of an association of sarcoidosis with service in the Southwest Asian theater. Therefore, the examiner concluded that it was less likely that the Veteran’s sarcoidosis was related to a specific exposure event during his service in Southwest Asia. Although it appears that the examiner stated that the Veteran’s sarcoidosis with liver involvement had a partially explained etiology, and therefore would not be considered “medically unexplained,” as noted by 38 C.F.R. § 3.317(a)(2)(ii), and therefore would not be the subject of an award of service connection under the provision of 38 C.F.R. § 3.317(a), there is no further rationale provided for this conclusion beyond indicating in the opinion that an etiology is not definitively known and that no association to service in Southwest Asia had been found in order for VA to find a presumption existed for that condition. The Board notes that a finding that there is not evidence of a presumption to service is not an adequate rationale to solely base a finding of no direct link to service, as such is a separate theory of entitlement. See Combee v. Principi, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Accordingly, a remand is necessary in order for an addendum opinion to be obtained that addresses whether the Veteran’s sarcoidosis is medically unexplained, or whether it is otherwise related to military service, to include service in Southwest Asia. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); Kowalski v. Nicholson, 19 Vet. App. 171, 179 (2005) (a VA examination must be based on an accurate factual premise). Regarding the sleep apnea, digestive disorder and dermatitis claims, the Veteran has at least in part claimed that they are secondary to his sarcoidosis claim. Accordingly, as they are intertwined with the above remanded claim, those claims are also remanded at this time. See Henderson v. West, 12 Vet. App. 11, 20 (1998); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: Obtain an addendum medical opinion from an appropriate physician, preferably a pulmonologist, as to the nature and etiology of the Veteran’s pulmonary sarcoidosis with extrapulmonary involvement of the liver. The claims folder, to include a copy of this Remand, must be made available to and reviewed by the physician prior to completion of the opinion, and the opinions must reflect that the claims folder was reviewed. Specifically, the examiner should opine as to whether the Veteran’s sarcoidosis at least as likely as not (50 percent or greater probability) is related to military service, to include service in Southwest Asia. In so addressing, the examiner should additionally address the June 2016 VA examiner’s findings and conclusions with regards to whether the Veteran’s sarcoidosis has a known etiology, or whether such is “medically unexplained” or has a “partially understood etiology.” For purposes of this latter discussion, the examiner is reminded that: The term medically unexplained chronic multisymptom illness means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multisymptom illnesses of partially understood etiology and pathophysiology, such as diabetes and multiple sclerosis, will not be considered medically unexplained. See 38 C.F.R. § 3.317(a)(2)(ii). In addressing the above opinions, the examiner should consider the Veteran’s lay statements regarding onset of symptomatology and any continuity of symptomatology since onset and/or since discharge from service. The examiner should also consider any other pertinent evidence of record, as appropriate. All findings should be reported in detail and all opinions must be accompanied by a clear rationale. MARTIN B. PETERS Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. KAYS HUKILL 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.