Citation Nr: 21009487 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 20-12 845 DATE: February 22, 2021 ORDER Service connection for sarcoidosis overlying the right lung apex, to include as exposure to Agent Orange is denied. FINDING OF FACT Sarcoidosis was not shown during the Veteran’s active duty service and was first diagnosed in 1998. While the Veteran is presumed to have been exposed to herbicide agents while serving in Vietnam, the weight of the probative evidence does not show any nexus between the Veteran’s lung sarcoidosis and his service. CONCLUSION OF LAW The criteria for service connection for sarcoidosis, to include as exposure to herbicide agents, have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1968 to July 1973. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Milwaukee, Wisconsin. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in, or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. That determination requires a finding of a current disability that is related to an injury or disease in service. Service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury that was incurred or aggravated in service. 38 C.F.R. § 3.303(d). Generally, to establish service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313(Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). However, the Veteran asserts that his current disability, lung sarcoidosis, is a result of his exposure to Agen Orange during while serving on active duty. A veteran is presumed exposed to herbicide agents, including Agent Orange, if he or she had active military, naval, or air service in the Republic of Vietnam from January 9, 1962 to May 7, 1975, unless there is affirmative evidence to establish that the veteran 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). If a veteran was exposed to Agent Orange during active service, service connection is presumed for a limited, enumerated list of diseases identified under 38 C.F.R. § 3.309(e). If a veteran was exposed to a herbicide agent, to include Agent Orange, during active military, naval or air service and has contracted one of the diseases on the enumerated list, to a degree of 10 percent or more at any time after service (except for chloracne and early-onset peripheral neuropathy, which must be manifested within a year of the last exposure to an herbicide agent during service), the veteran is entitled to a presumption of service connection, even if there is no record of such disease during service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309(e). Service personnel records confirm that the Veteran served in the Republic of Vietnam, during his active period of service, between June 1968 to July 1973. Thus, presumptive exposure to Agent Orange is conceded. However, the Veteran’s current diagnosis of lung sarcoidosis is not on the enumerated list of diseases that are presumptively associated with exposure to Agent Orange, and thus, service connection for lung sarcoidosis, on a presumptive basis, is not established. Nonetheless, this is not dispositive of the claim as direct service connection can still be established under 38 C.F.R. § 3.303(d), if there is evidence that the disability was incurred during or aggravated by service without regard to the statutory presumptions. See Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994). In this regard, service treatment records (STRs) do not show any evidence of an illness, disease, treatment, and/or diagnosis that may be related to lung sarcoidosis. Nonetheless, in support of his claim, the Veteran submitted a private opinion from a physician, Dr. M.M. In this February 2018 opinion, Dr. M.M. opined that it was more likely than not that the Veteran’s sarcoidosis is due to his exposure to Agent Orange. Although Dr. M.M. provided information about the history of the Veteran’s disability, as well as details he elicited from the Veteran, including pertinent information about the Veteran active service, he did not provide a rationale to support this opinion. Inadequate medical examinations include examinations that contain only data and conclusions, do not provide an etiological opinion, are not based upon a review of medical records, or provide unsupported conclusions. Nieves- Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Thus, the Board finds that this opinion is inadequate and thus, provides no probative value. In March 2018, the Veteran was afforded a VA examination for respiratory conditions. A VA examiner opined that it is less likely than not (less than 50 percent probability) that the Veteran’s lung sarcoidosis was incurred in or caused by an in-service injury, event, or illness. As the rationale for this opinion, the VA examiner reasoned that there are no medical records showing diagnosis or treatment for sarcoidosis condition during active duty. However, this opinion is inadequate as it is wholly based on the absence of evidence of in-service diagnosis or treatment for sarcoidosis. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). Therefore, this opinion is also inadequate and thus has no probative value in the determination of this claim. In a June 2018 correspondence, the Veteran asserted that this VA opinion was inadequate. He explained that the VA examiner “appeared to be in very much of a hurry”; he asked the Veteran 3 – 4 general questions about his case; and that the Veteran did not ask him anything about his Vietnam experiences and/or probable exposure to Agent Orange, and/or anything about the specifics of his sarcoidosis claim. Accordingly, the Veteran was afforded another VA examination in November 2019. After this examination, a VA examiner opined that the Veteran’s sarcoidosis was less likely than not incurred in or caused by an in-service injury, event, or illness. As the rationale for this opinion, the VA examiner explained, in pertinent part, that after a review of the evidence of record, as well as taking Dr. M.M. and the Veteran’s statements into consideration, current medical literature does not support a causal connection between Agent Orange and sarcoidosis; and that furthermore, the Veteran was not exposed to the occupational and environmental exposures known to cause sarcoidosis. See November 2019 VA examination report. In support of his claim, the Veteran also submitted medical literature from the website, NIH Public Access, entitled “Occupational Causes of Sarcoidosis.” Although this article discusses possible etiology, no mention is made about exposure to Agent Orange and/or a possible correlation to sarcoidosis. As a matter of fact, the summary of the article informs that there “is increasing evidence that sarcoidosis can occur in workplace settings in which there is exposure to both foreign antigens and inorganic triggers of inflammation that promote an exuberant granulomatous immune response” and that “it is likely that sarcoidosis has more than one cause.” However, this article is inapposite to the Veteran’s contentions, as he has not asserted that the cause of his sarcoidosis is due to occupational and environmental exposures, but rather, Agent Orange. Even if the Board were to liberally construe this article as the Veteran’s assertions of developing lung sarcoidosis as a result of occupational and environmental exposures, the Veteran has not identified the specific elements or chemicals that comprised an occupational and/or environmental exposure. Thus, the Board finds that this article while informative has no probative value in the determination of this claim. Additionally, the Veteran has submitted a previous Board opinion, which granted a claim for service connection for sarcoidosis. However, even though prior decisions in other appeals may be considered in a case, to the extent that they reasonably relate to the case, prior Board decisions are not precedential or binding. See 38 C.F.R. § 20.1303. Therefore, the Board finds that this prior Board decision has no probative weight in this current appeal, as it was based on a different evidentiary record. Thus, as the preponderance of the evidence is against this claim, service connection for lung sarcoidosis, to include as secondary to exposure to herbicide agents, must be denied. M. Tenner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board V-N. Pratt 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.