Citation Nr: 21023443 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 20-10 817 DATE: April 20, 2021 REMANDED Entitlement to service connection for sarcoidosis is remanded. Entitlement to service connection for a bladder disability, secondary to sarcoidosis, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1963 to October 1967. These matters come before the Board of Veterans’ Appeals (Board) from a February 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In a June 2020 decision, the Board denied the claim for service connection for a stomach disability and remanded the issues listed above for further evidentiary development. 1. Entitlement to service connection for sarcoidosis The Veteran contends she is entitled to service connection for sarcoidosis. Although the Veteran was not formally diagnosed with this condition until 1982, she argues her symptoms began in service. Specifically, she reports suffering from a variety of maladies in service, to include headaches, urinary problems, coughing up blood, and respiratory distress. In essence, she claims these in-service symptoms were manifestations of sarcoidosis but were “missed” as manifestations of that disease until her formal diagnosis in 1982. The Board notes the Veteran’s service treatment records contain a long history of treatment for a variety of symptoms, as she has described. This includes documented treatment for multiple respiratory infections, coughing up blood, multiple episodes of viral pharyngitis and laryngitis, and sore throat. At her September 1967 separation exam, the examiner noted the Veteran suffered from hemoptysis with upper respiratory tract infection approximately four years prior; however, her chest x-ray at that time was normal. The Veteran’s private medical records from the 1970s are not available. By 2003, her private doctor stated that all of her numerous symptoms could be explained by systemic sarcoidosis. The Board directed the RO to provide a VA Compensation and Pension (C&P) examination to evaluate the Veteran’s arguments. In August 2020, an examiner provided a negative opinion, stating there was “no objective evidence to support an etiology for the diagnosis of Sarcoidosis during, or due to service.” The examiner concluded the symptoms noted in service were not pathogenic for sarcoidosis, and that no imaging was done which was positive for the disease. In January 2021, the examiner provided an addendum stating it was less likely than not that the Veteran’s sarcoidosis began during or was caused by service. The examiner again noted the “available records do not establish a nexus.” The Board finds more development is needed. Although the C&P examiner’s opinions are quite detailed, insufficient attention was given to the difficulty in diagnosing sarcoidosis, the fact it can manifest through a wide variety of symptoms, and the fact it was not widely diagnosed during the Veteran’s period of active service (which, according to the Veteran, made it unlikely her providers considered the possibility of sarcoidosis in service). The Board finds it significant that the Veteran developed such a wide array of medical problems in service, which she has described as persisting and in fact getting worse since her discharge, culminating in a diagnosis of sarcoidosis. In light of the above, the Board finds a VHA medical opinion would be helpful in evaluating the Veteran’s contentions. 2. Entitlement to service connection for a bladder disability, as secondary to sarcoidosis, is remanded. The Veteran contends her bladder dysfunction is secondary to sarcoidosis. As such, the two claims are inextricably intertwined, and must both be remanded. See Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc) (explaining that claims are inextricably intertwined where the adjudication of one claim could have a significant impact on the adjudication of another claim); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. The RO should arrange to have the claims file forwarded to a VHA medical specialist for an opinion as to the nature and etiology of the Veteran’s sarcoidosis. The examiner must review the entire record. The examiner must provide opinions addressing the following: (a) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s sarcoidosis either developed in or was otherwise caused by active service? (b) In answering (a), the examiner should discuss any symptoms during and since service as shown by the medical evidence of record and as reported in lay statements by the Veteran (including in March 2020 correspondence). The examiner should note the Veteran’s contentions regarding the difficulty of diagnosing sarcoidosis, to include the fact the disease was not commonly diagnosed during her period of active service. (c) Is it at least as likely as not that the Veteran’s sarcoidosis manifested within one year of separation from active service? (Continued on the next page)   (d) The VHA medical specialist should include a detailed rationale in support of all opinions provided that considers the Veteran’s lay statements regarding the chronology of her symptoms and treatments. An opinion that relies solely on the absence of medical records will not be deemed adequate. If the examiner cannot provide an opinion without resorting to mere speculation, he or she must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner must explain whether the inability to provide a more definitive opinion is the result of a need for additional information that cannot be obtained from an interview with the Veteran, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. If the benefits sought are not granted to the Veteran’s satisfaction, send the Veteran and her representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Ryan, 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.