Citation Nr: 21007181 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 17-28 738A DATE: February 8, 2021 ORDER Service connection for sarcoidosis is granted. FINDING OF FACT With resolution of the doubt in his favor, the Veteran’s sarcoidosis was caused by service. CONCLUSION OF LAW The criteria to establish entitlement to service connection for sarcoidosis have been met. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303(d) (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Navy from January 1963 to December 1966, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2015 rating decision of the New York, New York Regional Office (RO). In May 2019, the Veteran was afforded a hearing before the undersigned Veterans Law Judge (VLJ) sitting at the RO. 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 September 2019, the Board remanded the appeal to the RO for additional action. There was substantial compliance with the Board’s remand directives. Stegall v. West, 11 Vet. App. 268 (1998). Service Connection – Sarcoidosis Service connection may be granted for a current disability arising from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110 (2012). Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2019). Service connection generally requires (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Sarcoidosis is a “chronic disease” listed under 38 C.F.R. § 3.309(a). Therefore, the provisions of 38 C.F.R. § 3.303(b) are for application. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The Veteran contends that his sarcoidosis was caused by his exposure to Agent Orange during service in Vietnam. As discussed below, although the Veteran’s sarcoidosis is listed as a chronic disease subject to presumptive service connection, the Board will grant the claim on a theory of direct service connection. Military personnel records (MPRs) reflect that the Veteran served aboard the U.S.S. Richard E. Kraus (U.S.S. Kraus) from February 1964 to November 1966. Although the Veteran’s MPRs do not reflect the U.S.S. Kraus having been in Vietnam, in July 2015, the Veteran submitted a VA document listing the U.S.S. Kraus as having operated on a coastal inlet north of Da Nang for several days in June 1966. http://www.publichealth.va.gov/exposures/agentorange/shiplist.list.asp. Resolving all reasonable doubt, the Veteran served in the Republic of Vietnam. 38 U.S.C. § 1154(a) (2012); 38 C.F.R. § 3.307(a)(6)(iii) (2019). Although the Veteran served in Vietnam and is presumed to have been exposed to herbicide agents, presumptive service connection under 38 C.F.R. § 3.309(e) is not applicable because sarcoidosis is not listed as a disease under § 3.309(e). 38 C.F.R. §§ 3.307(a)(6)(ii), 3.309(e) (2019). A May 1966 service treatment record (STR) reflects the Veteran’s report of experiencing a head cold and it was noted that the Veteran’s pharynx was inflamed. In the Veteran’s December 1966 separation medical examination report, no lung abnormalities were noted. In a January 1986 private treatment record, the Veteran reported having smoked one pack of cigarettes per day for approximately 15 years and that post-service, he was employed as a maintenance worker and exposed to “steel dust.” The private medical provider indicated that the Veteran “appears to have stable sarcoidosis.” Private treatment records dated 1987 to 2005 reflect the Veteran’s report of experiencing respiratory symptoms and a diagnosis of sarcoidosis. In a June 2014 private treatment record, the Veteran’s private medical provider indicated having treated the Veteran for sarcoidosis since 1986 and that sarcoidosis may have been present for at least ten years before his diagnosis in 1986. A July 2015 private treatment record reflects the Veteran’s report of experiencing shortness of breath. He was diagnosed with sarcoidosis. In a June 2017 letter, the Veteran’s private medical provider indicated having treated the Veteran for sarcoidosis and opined, without supporting rationale, that the Veteran’s sarcoidosis was caused by his exposure to Agent Orange. The private medical opinion is of low probative value because it is conclusory and does not provide the Board with any rationale to consider and weigh the opinion. Stefl v. Nicholson, 21 Vet. App. 120, 124-125 (2007) (holding that a mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision as to what weight to assign to a doctor’s opinion). In his May 2019 Board hearing, the Veteran testified to experiencing trouble breathing when he “first got out of the service.” He also testified to having smoked cigarettes for approximately ten years and that he quit in 1977. In a June 2019 addendum to the June 2017 private medical opinion, the examiner indicated that the Veteran’s lung impairment was not caused by cigarette use and opined that his sarcoidosis was caused by exposure to Agent Orange because “medical evidence” revealed an abnormal immune response to exogenous material as the basis for granuloma formation in lung tissues and other organs. The private medical opinion has some probative value because although the examiner did not identify the “medical evidence” used in support of the rationale and conclusion, the rationale was, nonetheless, sufficient to support the medical conclusion. Bloom v. West, 12 Vet. App. 185, 187 (1999) (holding that the value of a physician’s statement is dependent, in part, upon the extent to which it reflects clinical data or other rationale to support the opinion). In the December 2020 VA examination, the Veteran reported experiencing respiratory symptoms, such as shortness of breath and frequent colds in the 1970s. The Veteran was diagnosed with sarcoidosis. The examiner indicated that sarcoidosis was an inflammatory disease that can affect multiple bodily organs but mostly the lungs and lymph glands. The examiner also indicated that the cause of sarcoidosis was unknown but it is thought that bacteria, viruses, or chemical exposure might trigger the disease, or that it may be genetic. The VA examiner opined that the Veteran’s sarcoidosis was not caused by his exposure to Agent Orange because sarcoidosis was not recognized as a presumptive Agent Orange condition. The VA medical opinion is of low probative value because the examiner’s rationale – that sarcoidosis was not a recognized presumptive disease – is not sufficient to support the conclusion that the Veteran’s sarcoidosis was not caused by his exposure to Agent Orange in Vietnam. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). The Board will grant the claim based on the benefit-of-the-doubt doctrine. The June 2019 private examiner opined that the Veteran’s sarcoidosis was not caused by cigarette smoking and that it was caused by his exposure to Agent Orange in Vietnam. The December 2020 VA examiner opined otherwise; however, the VA medical opinion was of low probative value. The Board will resolve all reasonable doubt in favor of the Veteran. Therefore, service connection is warranted and the claim is granted. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Cohen, 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.