Citation Nr: 21025627 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 15-04 723 DATE: April 28, 2021 ORDER Entitlement to service connection for sarcoidosis, to include as due to exposure to herbicide agents, is denied. FINDING OF FACT The Veteran did not have sarcoidosis during active duty and the disorder is not related to military service to include exposure to herbicide agents. CONCLUSION OF LAW The criteria for service connection for sarcoidosis are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303(a), 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran retired from military service after serving on active duty between October 1965 and July 1988. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a rating decision by a U.S. Department of Veterans Affairs (VA) Regional Office (RO). In November 2017, the Veteran testified in a Board hearing conducted by a Veterans Law Judge (VLJ) who has retired from the Board. A transcript of the hearing is of record. In February 2021, the Board offered the Veteran an opportunity for another hearing to be conducted by a VLJ who would decide his claim. The Veteran did not respond to the offer. In February 2020, the Board remanded the case for further development, which has been completed. Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection The Veteran contends that he incurred sarcoidosis as the result of herbicide exposure during service in the Republic of Vietnam. Law and regulations Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. To establish a right to compensation for a present disability, a veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Where a Veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases, such as sarcoidosis, to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. In some cases, service connection may also be established under 38 C.F.R. § 3.303(b) by (a) evidence of (i) a chronic disease shown as such in service (or within an applicable presumptive period under 38 C.F.R. § 3.307) and (ii) subsequent manifestations of the same chronic disease, or (b) if the fact of chronicity in service in not adequately supported, by evidence of continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The governing law provides that a “veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975 shall be presumed to have been exposed during such service to an herbicide agent... 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). Furthermore, VA regulations provide that, if a veteran was exposed to an herbicide agent during active service, presumptive service connection is warranted for certain disorders. 38 C.F.R. § 3.309(e). Sarcoidosis is not a condition which VA presumes as due to Agent Orange exposure. However, when a claimed disorder is not included as a presumptive disorder, direct service connection may nevertheless be established by evidence demonstrating that the disease was in fact “incurred” during the service. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be granted to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on the merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Evidence and analysis The evidence in this matter consists of lay assertions from the Veteran, service treatment records (STRs), VA treatment records, and VA examination reports. This evidence indicates that a service connection finding is unwarranted here. The evidence establishes that the Veteran has sarcoidosis. This is demonstrated most recently in a September 2020 VA examination report. The evidence also establishes that the Veteran was exposed to herbicides during service in Vietnam. However, a preponderance of the evidence indicates that the current disorder is unrelated to the herbicide exposure. And the record contains no evidence indicating onset of the disorder within the first year of retirement from service in 1988. The STRs do not reflect any complaints, findings, treatment, or diagnosis of sarcoidosis. Clinical examination of the lungs, skin and lymphatic systems which was conducted in December 1968, December 1977, November 1978, and June 1987 all showed “normal” results for “lungs and chest,” and “skin, lymphatics.” The Veteran’s STRs do include one treatment note in April 1973 that stated the Veteran had been coughing with a feverish feeling for the prior 2 days, with a medical impression of mild bronchitis. See April 1973 STR. Additionally, the clinician noted that the Veteran smoked 1 ½ packs of cigarettes per day. This single reference to a cough during service was not diagnosed as being due to sarcoidosis. The earliest post-service treatment notes that indicate a possibility of sarcoidosis is a VA radiology report dated in June 1998 which showed mild overexpansion of the lungs and bilateral hilar lymphadenopathy. See June 1998 Medical Records. A May 2006 VA examiner included an impression of mediastinal adenopathy and differential diagnoses included sarcoidosis. See May 2006 Medical Records. It was also stated that VA treatment records in August 2006 revealed that biopsies supported the clinical diagnosis of sarcoidosis. See August 2006 Medical Records; see 38 C.F.R. § 3.307 (a)(3). When the Veteran received his treatment in 1998, he did not report a history of respiratory symptoms during the one-year presumptive period. Thus, the evidence demonstrates that the Veteran's sarcoidosis was not shown to be a chronic disease in service, exhibited no continuity of symptomatology, and did not manifest within a year of service. See 38 C.F.R. §§ 3.303 (b), 3.307(a)(3), 3.309(a). In addition, in September 2020, a VA opinion addressed the claim. The examiner gave a negative opinion that the Veteran’s sarcoidosis was due to military service. See September 2020 VA Examination. The examiner noted that the Veteran reported a fever and cough in 1973 during service with no further in-service complaints. The examiner also reported that the Veteran had a normal chest X-ray on August 24, 1987. The Veteran did not have any abnormalities in his chest X-ray until June 18, 1998, which was approximately 10 years after he exited service. The examiner further noted that the STRs are silent for sarcoidosis, with no evidence of sarcoidosis until 1998 and a formal diagnosis in August 2006. The examiner determined that the Veteran’s reported symptoms in 1973 were consistent with a viral illness which resolved without additional problems. The examiner opined that it was unlikely that the in-service complaint of a cough and fever in April 1973 was an earliest manifestation of, or marked the onset of, sarcoidosis. In determining the probative value to be assigned to a medical opinion, the Board must consider three factors: whether a medical expert was fully informed of the pertinent factual premises (i.e., medical history) of the case; whether the medical expert provided a fully articulated opinion; and whether the opinion is supported by a reasoned analysis. The most probative value of a medical opinion comes from its reasoning. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). In this case, the examiner was aware of the Veteran's medical history, provided a fully articulated opinion, and furnished a reasoned analysis for the conclusions. The Board therefore attaches significant probative value to this opinion. There is no other competent medical opinion to the contrary, moreover. The Board also reviewed the Veteran's lay statements in which he reported that his sarcoidosis was connected to his service. At the November 2017 hearing, he testified that he was exposed to a large volume of Agent Orange and contended that he had several episodes of breathing problems per year during and since service. See November 2017 Board Hearing Transcript. The objective treatment records do not corroborate the Veteran’s contention that he has had several episodes of breathing problems per year during and since service. The Veteran is competent to report having had trouble breathing but is not competent to provide a diagnosis of sarcoidosis in service or within a presumptive period, or a medical opinion linking sarcoidosis to service. Opinions regarding the diagnosis and etiology of sarcoidosis are complex and generally beyond the competency of a lay witness. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). As such, the Board gives more probative weight to the 2020 VA medical opinion and the objective treatment records that document sarcoidosis diagnosis in August 2006, over 17 years following service retirement. (Continued on the next page) In sum, the preponderance of the evidence is against finding that the Veteran's sarcoidosis was due to an in-service disease, injury, or event; or was manifest within a presumptive period. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. In the absence of a nexus, the criteria for service connection for sarcoidosis are not met and the appeal must be denied. C. J. McEntee Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board V. Schmidt 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.