Citation Nr: 21015596 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 14-26 679 DATE: March 17, 2021 ORDER Entitlement to service connection for sarcoidosis is denied. REMANDED Entitlement to service connection for rheumatoid arthritis (RA), to include as secondary to service-connected herniated nucleus pulposus (HNP), is remanded. FINDING OF FACT The preponderance of the evidence is against finding that sarcoidosis began during active service, is otherwise related to an in-service injury or disease or that sarcoidosis manifested within one year of service discharge. CONCLUSION OF LAW The criteria for service connection for sarcoidosis are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active service in the U.S. Army from August 1995 to May 2003. These matters are before the Board of Veterans Appeals (Board) on appeal of September and November 2013 rating decisions by the Department of Veterans Affairs (VA) Regional Offices (RO) in Guaynabo, Puerto Rico and Roanoke, Virginia, respectively. This case was remanded for additional development in April 2018 and August 2020. In August 2020, the Board instructed that VA notify the Veteran of the inability to obtain specific private treatment records, obtain treatment records from Walter Reed National Military Medical Center and Fort Belvoir Community Hospital and obtain etiology opinions. The Veteran was asked to complete an appropriate authorization form to allow VA to obtain treatment records on her behalf and informed her that she may submit the records on her own in an August 2020 letter, treatment records from Walter Reed National Military Medical Center and Fort Belvoir Community Hospital and a VA etiology opinion was obtained in November 2020. Therefore, the Board determines that there has been substantial compliance with its previous remand with regards to the claim for service connection for sarcoidosis. Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection 1. Entitlement to service connection for sarcoidosis is denied. The Veteran asserts that she has sarcoidosis either incurred in or due to service. Specifically, the Veteran argues that her sarcoidosis is due to service in Turkey. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service treatment records show the Veteran complained of cough with diagnoses of sinusitis and upper respiratory infections. Upon Medical Evaluation Board (MEB) medical history report dated in July 2001, the Veteran denied chronic cough and shortness of breath. In examinations dated in May 2002 and November 2002, the examiners noted the Veteran’s lungs and chest as normal. Post-service private treatment records show a diagnosis of sarcoidosis in February 2011. The Board has first considered whether service connection is warranted on a presumptive basis. However, the clinical evidence of record fails to show that the Veteran manifested sarcoidosis to a degree of 10 percent within the one year following her discharge from service in May 2003. In this case, the post-service clinical record establish that the Veteran was diagnosed with sarcoidosis in February 2011. As such, presumptive service connection is not warranted for sarcoidosis. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. The Veteran underwent a VA examination in September 2019; however, the examiner found there was insufficient objective evidence to support Veteran’s claim of sarcoidosis and no diagnosis warranted. The AOJ obtained an additional VA opinion dated in November 2020. The examiner opined that the Veteran’s sarcoidosis is not at least as likely as not related to an in-service injury, event, or disease, including in-service coughing. The rationale was that although the Veteran was treated for a cough during service, these symptoms were related to service-connected allergies. The examiner noted the service treatment records do not reveal any pulmonary conditions during service, that the chest X-rays obtained during service in 2001 and 2002 for annual physicals were normal and that the separation examination also did not show any respiratory problems. Further, the examiner noted that the Veteran was not diagnosed with sarcoidosis until 2011, approximately eight years after service. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). There is no contrary probative opinion of record. The Veteran believes her sarcoidosis is related to an in-service injury, event, or disease. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of pathology. Therefore, it is outside the competence of the Veteran in this case because the record does not show that she has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the VA opinion of record. The probative evidence shows that the Veteran’s sarcoidosis had its onset several years after service and there is no competent evidence to link the Veteran’s sarcoidosis with an incident of service. Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for sarcoidosis is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to service connection for RA, to include as secondary to service-connected herniated nucleus pulposus, is remanded. The August 2020 Board remand requested a VA opinion which address the etiology of the Veteran’s RA to include on both direct and secondary theories of entitlement. While the November 2020 VA examiner found the Veteran’s RA was not caused by or aggravated by the Veteran’s service-connected herniated nucleus pulposus, the examiner failed to provide an opinion as to direct service connection. See Stegall v. West, supra. As such, a remand is necessary for an addendum opinion. The matter is REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claim on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and her representative and afford her an opportunity to submit any copies in her possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, obtain an addendum etiology opinion by an appropriate clinician to determine the nature and etiology of the Veteran’s claimed RA. The examiner should review the entire claims file and note such review in the opinion. The need for further in-person examination is left to the discretion of the examiner. The examiner should respond to the following question: Is it at least as likely as not (50 probability or greater) that the Veteran’s current RA had its onset during service or is otherwise related to service? A rationale should be provided for all opinions offered. If it is not possible to provide a specific opinion regarding the above questions, 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). The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. M. Donahue Boushehri, 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.