Citation Nr: 21065561 Decision Date: 10/26/21 Archive Date: 10/26/21 DOCKET NO. 20-14 965 DATE: October 26, 2021 ORDER Entitlement to service connection for sarcoidosis is granted. FINDING OF FACT The evidence is at least evenly balanced as to whether the Veteran's sarcoidosis is related to service. CONCLUSION OF LAW With reasonable doubt resolved in favor of the Veteran, the criteria for entitlement to service connection for sarcoidosis have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1970 to April 1974. This case comes before the Board of Veterans' Appeals (Board) on appeal from a July 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO), which, among other things, denied entitlement to service connection for sarcoidosis. In December 2018 the Veteran filed a notice of disagreement (NOD) and in January 2020 the RO issued a statement of the case (SOC). In March 2020 Veteran timely filed a substantive appeal (via VA Form 9). In September 2021, the Veteran testified during a virtual hearing before the undersigned Veterans Law Judge. The hearing transcript is not currently associated with the record. However, as the instant decision grants the benefit sought in full, there is prejudice to the Veteran by proceeding without the hearing transcript. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service incurrence of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The law also provides that diseases associated with exposure to certain herbicide agents used in support of military operations in the Republic of Vietnam and in certain locations elsewhere during the Vietnam era will be considered to have been presumptively incurred in service. 38 U.S.C. § 1116(a)(1); 38 C.F.R. § 3.307(a)(6). A veteran is presumed to have been exposed to herbicides if he or she served in Vietnam between January 9, 1962, and May 7, 1975 (Vietnam era), unless there is affirmative evidence to establish that he was not exposed to any such agent during that service. 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307 (a)(6)(iii). The presumption of service connection requires exposure to an herbicide agent and manifestation of the disease to a degree of 10 percent or more within the time period specified for each disease. 38 C.F.R. § 3.307(a)(6)(ii). If a veteran did not serve in the Republic of Vietnam during the Vietnam era, hr must show actual exposure to herbicide agents. Sarcoidosis A May 1998 private treatment note indicates that the Veteran is diagnosed with sarcoidosis. Also, a June 2018 VA examiner noted that the Veteran was diagnosed with sarcoidosis dating back to 1983. Thus, a current disability has been demonstrated. The Veteran contends that he is entitled to service connection for sarcoidosis due to in-service exposure to herbicide agents. Specifically, in a February 2018 Statement in Support of Claim (VA Form 21-4138) the Veteran stated that he was stationed at Gulfport, Mississippi, and moved barrels filled with agent orange without any protective gear. The Veteran also stated that he was stationed at Camp Lejeune and was exposed to contaminated water. On the Veteran's March 2020 VA Form 9, the Veteran stated that medical literature suggests that sarcoidosis can be an immune system response to exposure to environmental and chemical contaminants. The Veteran's current sarcoidosis is not among the conditions for which VA has specifically determined a presumption of service connection is warranted based on exposure to herbicide agents. See 38 U.S.C. § 1116(a)(2) and 38 C.F.R. § 3.309(e). As a result, entitlement to service connection on a presumptive basis is not warranted. Nevertheless, consideration of whether a grant of service connection on a direct basis is still necessary in this case. See 38 U.S.C. § 1113(b); 38 C.F.R. § 3.303(d) (the availability of service connection on a presumptive basis does not preclude consideration of service connection on a direct basis); Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994) (when a veteran is found not to be entitled to a regulatory presumption of service connection for a given disability, the claim must nevertheless be reviewed to determine whether service connection can be established on a direct basis). The Veteran's service treatment records (STRs) do not show that he sought treatment or reported sarcoidosis, or any other symptoms associated with this disability while in service. However, the Veteran's personnel records demonstrate that he served in Gulfport, MS and worked as a utilities service mechanic with the Naval Mobile Construction Battalion. In an April 2018 email, a VA official reviewed the Veteran's file and determined that "it is accepted that the Veteran had performed duties to include moving Agent Orange barrels" while stationed at Gulfport, MS. Thus, the in-service injury or disease requirement has been met by showing exposure to herbicide agents. The remaining question is whether a nexus exists between the Veteran's current sarcoidosis and the herbicide agent exposure. In an October 2021 letter, the Veteran's private physician opined that it is more likely than not that the Veteran's exposure to toxic chemicals during service caused his sarcoidosis. The private physician explained that sarcoidosis is a dyscrasia that has no definitive etiology and a plethora of etiology theories have been proposed including but limited to occupational exposures, viral/fungal/non-tuberculosis infections, and/or environmental factors. The private physician explained that the National Library of Medicine literature connects sarcoidosis with direct handling of wartime chemicals. The private physician further explained that the Veteran was not apprised of adequate safety measures when he performed his in-service duties. While the October 2021 private physician relied on the service history provided by the Veteran, the discounting of a medical opinion that relied on service history provided by the Veteran is only warranted in certain circumstances, none of which are present here. See Coburn v. Nicholson, 19 Vet. App. 427, 432-433 (2006) (reliance on the service history provided by the veteran only warrants the discounting of a medical opinion in certain circumstances, such as when the opinions are contradicted by other evidence in the record or when the Board rejects the statements of the veteran). As there is no contradictory evidence, the October 2021 private medical opinion is afforded significant probative value. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). Given the positive nexus opinion, the evidence is at least evenly balanced as to whether the Veteran's sarcoidosis is related to service. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for sarcoidosis is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board James R. Miller, Associate Counsel 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.