Citation Nr: 21063667 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 18-22 974A DATE: October 15, 2021 REMANDED The issue of service connection for sarcoidosis is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from September 1980 to September 1983. The Veteran also served in the New Jersey Army National Guard from September 1984 to January 2008. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2017 rating decision of the New Orleans, Louisiana Regional Office (RO). In December 2019, the Veteran was afforded a videoconference hearing before the undersigned Veterans Law Judge (VLJ). During the hearing, the VLJ engaged in a colloquy with the Veteran toward substantiation of the claim. Bryant v. Shinseki, 23 Vet. App. 488, 496-97 (2010). A hearing transcript is in the record. In March 2020, the Board remanded the appeal to the RO for additional action. The RO did not substantially comply with the Board's remand directives. Stegall v. West, 11 Vet. App. 268 (1998). Sarcoidosis 1. BACKGROUND FOR THE RO ADJUDICATOR An April 2018 non-VA treatment record reflects the Veteran's report that the Veteran and her spouse both "served in similar locations" and that both were diagnosed with sarcoidosis. The non-VA examiner concluded that "this raised the possibility of certain exposure." The examiner's comment as to "the possibility of certain exposure" is unclear. Further the evidence shows that the Veteran served in Korea and Fort Sill, Oklahoma during active-duty service. However, the evidence does not reflect and the Veteran has not indicated where her spouse served, therefore, a remand is warranted to determine the spouse's duty locations. 38 C.F.R. § 3.159(c). The November 2020 VA negative etiology opinion was inadequate because the examiner did not consider the April 2018 non-VA treatment record and did not determine whether any medical relevance may be attached to the four articles submitted by the Veteran. THE REMAND DIRECTIVES FOLLOW: 2. If, and only if she desires to do so, advise the Veteran to identify her spouse's duty locations. 3. Further advise the Veteran that she may contact the April 2018 non-VA treatment provider and obtain any further information as to "the possibility of certain exposure" to any substances that would cause the disorder in question. The Veteran is advised that she should solicit the basis of the medical care treatment provider's opinion. 4. After the Veteran's response, conduct any appropriate research into the "possibility of certain exposures" as reported by the non-VA treatment provider. 5. Send the file to a VA pulmonologist for a file review and an addendum opinion. All relevant medical and non-medical records must be made available to the VA pulmonologist for review of pertinent documents. The examination report should specifically state that such a review was conducted. The VA pulmonologist must provide a comprehensive explanation for all opinions provided. Was the Veteran's sarcoidosis caused by her claimed exposure to fiberglass filters in closed telecommunication centers as an automatic data telecommunications center operator while stationed in Korea and/or Fort Sill, Oklahoma? Did the Veteran have a combination of manifestations sufficient to identify sarcoidosis during active-duty service? Did the Veteran's sarcoidosis manifest to a compensable degree within one year from the date of active-duty service separation? THE VA PULMONOLOGIST MUST DETERMINE WHAT, IF ANY, MEDICAL RELEVANCE MAY BE ATTACHED TO (1) BOTH THE VETERAN AND HER SPOUSE BEING IN "SIMILAR" DUTY LOCATIONS AND (2) THE FOUR ARTICLES SUBMITTED BY THE VETERAN IDENTIFIED BELOW Although the VA pulmonologist must review the VBMS file, his or her attention is drawn to the following: In the Veteran's service medical examination reports dated September 1984, November 1988, September 1992, and May 1998, the service medical examiner noted no lung and chest abnormalities. In her service medical history reports dated September 1984, November 1988, and September 1992, the Veteran answered "no" to the question of whether she then had, or once had shortness of breath, chest pain, or pressure. In a March 1994 service annual medical certificate, the Veteran answered "no" to the question of whether she then had any medical problems. In her May 1998 service medical history report, the Veteran answered "no" to the question of whether she then had, or once had shortness of breath, chest pain, or pressure. A July 2001 non-VA treatment record reflects the Veteran's report of chest pain and exercise protocol testing, myocardial perfusion scintigraphy, myocardial perfusion imaging, and radionuclide ventriculography revealed normal findings. In her February 2002 service medical history report, the Veteran answered "no" to the question of whether she then had, or once had shortness of breath, chest pain, or pressure. In March 2002, the Veteran underwent non-VA pharmacologic stress protocol testing, myocardial perfusion imaging, and radionuclide ventriculography that revealed normal findings. In an October 2005 post-deployment health assessment pertaining to Katrina relief efforts, the Veteran answered "no" to the question of whether she then had, or developed during deployment trouble breathing, chest pain, or pressure. In her September 2006 service medical history report, the Veteran answered "no" to the question of whether she then had, or once had shortness of breath, chest pain, or pressure. In the Veteran's September 2006 service medical examination report, the service medical examiner noted no lung and chest abnormalities. In her January 2007 service annual medical certificate, the Veteran answered "no" to the question of whether she then had any medical problems. In an October 2016 non-VA treatment record, the Veteran reported shortness of breath and coughing since June 2016 and a computerized tomography (CT) scan revealed sarcoidosis. A February 2017 non-VA treatment record reflects a diagnosis of sarcoidosis. A July 2017 chest radiograph revealed sarcoidosis. In an April 2018 letter, a non-VA examiner noted the Veteran's chest radiograph revealed ground glass infiltrate and mediastinal adenopathy leading to a biopsy consistent with sarcoid. It was noted that the Veteran's spouse had sarcoid and that both "served together at similar locations." During the December 2019 Board hearing, the Veteran testified that "the contamination occurred during active duty" while the Veteran was stationed in Korea and Fort Sill, Oklahoma working in "closed filtration systems, commonly using filters as fiberglass." Articles submitted by the Veteran in support of her claim: o A November 1961 article titled "Sarcoidosis in the U.S. Army, 1952 through 1956." o An April 1998 article titled "Sarcoidosis diagnoses among U.S. Military Personnel: trends and ship assignment associations." o A February 2018 article titled "New Advances In The Development Of Sarcoidosis Models: A Synopsis Of A Symposium Sponsored By The Foundation For Sarcoidosis Research." o An October 2019 one-page abstract titled "Sarcoidosis In Veterans: Environmental Exposures In Deployment." 6. Readjudicate the issue on appeal. If the benefit sought on appeal remains denied, the Veteran should be provided a supplemental statement of the case (SSOC). An appropriate period should be allowed for response before the case is returned to the Board. Vito A. Clementi Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Cohen, Counsel The Board's decision is only binding on this case. This action is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.