Citation Nr: 21009318 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 16-58 723 DATE: February 22, 2021 REMANDED Entitlement to an increased rating for sarcoidosis, denoted by rash of the extremities, swelling of the upper eyelids, lesion on the nasal tip, and nodule behind the left ear, rated at 10 percent prior to August 7, 2012 and 30 percent thereafter is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1992 to October 2001. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in August 2019. At that time, the Board denied the claims for an increased rating for sarcoidosis and a TDIU. The Veteran appealed to the United States Court of Appeals for Veterans Claims (CAVC). Pursuant to a Joint Motion for Remand (JMR) entered into by the Veteran and VA, CAVC vacated the August 2019 Board decision and remanded the claims for an increased rating for sarcoidosis and a TDIU. Entitlement to an increased rating for sarcoidosis Pursuant to the terms of the JMR, the claim for an increased rating for sarcoidosis was remanded to address whether the Veteran was entitled to a 60 percent rating at any time during the appeal period based on the evidence that he was prescribed prednisone and methotrexate. The JMR directed the Board to address whether the evidence of such treatment consisted of constant or near-constant systemic therapy so as to warrant a 60 percent rating under 38 C.F.R. § 4.118, Diagnostic Code 7806. VA treatment records reflect that the Veteran was prescribed prednisone and methotrexate at various times during the appeal period, including by a private pulmonologist. The Veteran reported to the September 2012 VA examiner that he was previously followed by a private pulmonologist. The records from the private pulmonologist are not associated with the record. The Board also notes that the Veteran contends that the total area covered by his skin condition has not been adequately examined because it is intermittent and was not necessarily evident during his VA examinations. Based on the foregoing, the Board finds that remand is warranted to obtain the private treatment records and afford the Veteran a VA examination to address whether he had constant/near constant systemic therapy and/or a rash that covered more than 40 percent of his body at any time during the appeal period. TDIU The issue of entitlement to a TDIU is inextricably intertwined with the issue of entitlement to an increased disability rating for sarcoidosis. Accordingly, the claim for a TDIU must also be remanded pending the outcome of the intertwined claim. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The Board also notes that the Veteran’s employment status during the appeal period is unclear from the record. Accordingly, on remand, the Veteran should be provided an opportunity to provide VA with evidence regarding his employment status during the appeal period. The matters are REMANDED for the following action: 1. Obtain pertinent, outstanding VA private treatment records and associate them with the claims file. Specifically, take all appropriate steps to obtain the treatment records from the Veteran’s private pulmonologist. 2. Send a letter to the Veteran requesting clarification of his employment status during the appeal period, including his wage earnings. Associate such documents with the claims file. Any negative responses should be properly noted in the record. 3. Following the development in items 1 and 2, schedule the Veteran for a VA examination with an appropriate clinician to evaluate the Veteran’s sarcoidosis. The examiner must be provided with and review the entire claims file, to include a copy of this remand. All appropriate tests and studies should be conducted. Following a review of the evidence of record, to include lay statements and an examination of the Veteran, the examiner should respond to the following: (a.) The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under Diagnostic Code 7806. The examiner must attempt to elicit information regarding the severity, frequency and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify the percentage of the body that is affected by the Veteran’s sarcoidosis during a flare-up, even if the condition is quiescent at the time of examination. In rendering this opinion, the examiner is asked to specifically address the Veteran’s contention that the rash covers more than 40 percent of his body. (b.) The examiner should also discuss the medications used to treat the condition throughout the claim period, to include the frequency of use and duration of the treatment. May the medication prescribed for the Veteran’s sarcoidosis be considered constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during any 12-month period? In rendering this opinion, the examiner is asked to specifically address the reports in the VA treatment records that the Veteran was prescribed prednisone and methotrexate. (c.) The examiner should also offer an opinion on the functional impairment caused by the Veteran’s service-connected sarcoidosis, relative to the Veteran’s ability to obtain and maintain substantially gainful employment during the appeal period. The examiner must provide a rationale for the opinion, citing to specific evidence in the record. 4. All findings and conclusions should be supported with a complete rationale reflecting consideration of the medical and lay evidence of record. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, systemic therapy or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). S.C. KREMBS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Snyder, 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.