Citation Nr: 21026006 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 17-06 158 DATE: April 29, 2021 ORDER Service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is granted. REMANDED Entitlement to service connection for sarcoidosis is remanded. Entitlement to service connection for a lung disability, separate from sarcoidosis is remanded. Entitlement to service connection for a heart disorder is remanded. Entitlement to service connection for a kidney disability is remanded. FINDING OF FACT The competent and probative evidence shows that the Veteran’s current PTSD is related to his claimed in-service stressor by a psychologist. CONCLUSION OF LAW The criteria for service connection for PTSD are met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. § 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the United States Navy from September 1975 to September 1979. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a December 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a Travel Board hearing in November 2019 at Winston-Salem, North Carolina; a transcript of that hearing is of record. These matters were subsequently remanded by the Board in January 2020 for additional development. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. In order to establish entitlement to service connection, there must generally be 1) evidence of a current disability; 2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and 3) causal connection between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection for PTSD requires a medical diagnosis conforming to the requirements of section 4.125(a), an in-service stressor accompanied by credible and supporting evidence that the stressor claimed to be the cause of the disorder occurred in service, and established medical evidence connecting the current disability to the stressor. 38 C.F.R. § 3.304(f); see also 38 C.F.R. § 4.125(a); Cohen v. Brown, 10 Vet. App. 128, 138-140 (1997). If a stressor claimed by the Veteran is related to his fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the Veteran’s symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the Veteran’s service, the Veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f)(3). The Veteran is competent to report symptoms and experiences observable by his senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed Cir. 2009). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 57-58 (1990). 1. Entitlement to service connection for an acquired psychiatric disorder. The Veteran asserts service connection for an acquired psychiatric disorder. After reviewing the relevant lay and medical evidence, the Board concludes that the Veteran has a current diagnosis of PTSD, and that the evidence shows that it is related to his in-service stressor. 38 U.S.C. §§ 1131, 5107(b). The Veteran has a diagnosis of PTSD to include as made by a psychologist in November 2020. As such, the first element of service connection is met. He submitted a statement in November 2014 where he reported falling off the catwalk and had nearly fallen off the ship. He has had nightmares of falling since his experience. The Board finds the Veteran to be competent to describe his experiences. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The Board finds his statements to be credible as they are consistent with his military service and other evidence of record, to include his testimony at the Board hearing. The November 2020 examiner provided a positive nexus opinion. She explained that it is common for veterans to avoid reporting events of mental illness during service. She noted the statements from the Veteran’s ex-wife describing the Veteran’s nightmares as well as him grabbing her during his sleep to prevent her from falling. The psychologist also stated that the Veteran did not have any traumatic experiences outside of service. The Board finds this opinion to have probative value. Although somewhat conclusory, the Board finds it has adequate rationale and considers the Veteran’s statements, his history, as well as lay statements. After review of the competent and probative evidence, the Board finds that when resolving reasonable doubt in favor of the Veteran, the evidence tends to show that his PTSD is due to his in-service accident where he fell on his ship. The Board has found the Veteran competent and credible to describe his experiences in service. He has remained consistent during the period on appeal and the Board finds such consistency adds to his credibility. The November 2020 examiner provided a positive nexus statement for the Veteran’s PTSD and explained that it is common for veterans to not report their mental health symptoms during service. Additionally, there is no negative service connection opinions. Therefore, resolving reasonable doubt in favor of the Veteran, service connection for PTSD is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 3.303. In a February 2021 correspondence, the Veteran’s representative asked for a 70 percent rating for the Veteran’s PTSD , if granted. The Board does not assign an initial rating in the first instance to preserve the Veteran’s due process rights. The RO will assigned an initial rating for PTSD as well as an effective date upon implementation of the grant of service connection by this decision.   REASONS FOR REMAND 1. Entitlement to service connection for sarcoidosis is remanded. The Veteran asserts service connection for sarcoidosis. He has a current diagnosis of sarcoidosis to include as reported at the October 2020 examination. As such, the first element of service connection is met. The examiner provided a negative nexus opinion stating that there is no evidence in medical literature that suggests silica dust inhalation is a potential cause of sarcoidosis. Since the negative opinion, the Veteran’s attorney has submitted medical articles regarding silica inhalation and sarcoidosis. As such, the Board finds that an addendum opinion that considers and addresses the submitted articles is warranted. 2. Entitlement to service connection for a lung disability, separate from sarcoidosis, is remanded. 3. Entitlement to service connection for a heart disorder is remanded. 4. Entitlement to service connection for a kidney disability is remanded. The Veteran asserts service connection for a lung disorder separate from sarcoidosis, heart disorders, and kidney disorders, to include as secondary to sarcoidosis. He has current diagnoses of OSA, chronic kidney disease, hypertension, and coronary artery disease, to include as reported in August 2020 VA treatment records. See 8/24/2020, CAPRI – DX, at p. 6. The November 2020 examiner provided negative nexus opinions for his heart disorders, and kidney disorders finding they were not related to service. However, as the Veteran has asserted they are secondary to his sarcoidosis, and his claim for service connection for sarcoidosis is being remanded, the Board finds that they are inextricably intertwined with the remanded claims of sarcoidosis. See Harris v. Derwinksi, 1 Vet. App. 180, 183 (1991) (noting that two issues are “inextricably intertwined” when they are so closely tied together that a final Board decision on one issue cannot be rendered until the other issue has been considered). As such, these issues are deferred pending the receipt of additional evidence, as directed below. These matters are REMANDED for the following actions: 1. Obtain any outstanding VA treatment records. All requests and responses for the records must be documented. If any identified records cannot be obtained, notify the Veteran of the missing records, the efforts taken, and any further efforts that will be made by VA to obtain such evidence, and allow him an opportunity to provide the missing records. 2. After associating any treatment records with the claims file, then schedule the Veteran for an appropriate examination to determine the etiology of the Veteran’s sarcoidosis disability and any other lung disability, to include obstructive sleep apnea. Please try to have an examiner with some specialized knowledge of respiratory disorder. If one is not available for the physical examination, then send the file for review by a physician with specialized training in respiratory disorders. The claims file is to be made available to the examiner and reviewed in conjunction with the examination. Then, (a.) Is it at least as likely as not (50 percent or greater probability) that his sarcoidosis was caused by a disease or injury in service, to include silica inhalation? See 11/6/2019, Hearing Transcript. --Next, identify and list any lung disability separate from sarcoidosis during the period on appeal (September 2011 onward), to include obstructive sleep apnea. Then, address: (a.) Is it at least as likely as not (50 percent or greater probability) that his disability was caused by a disease or injury in service, to include silica inhalation? See 11/6/2019, Hearing Transcript. (b.) If no, is it at least as likely as not (50 percent or greater probability) that the Veteran’s disability was either 1) proximately due to OR 2) aggravated by any service-connected disability? **The Board notes that the Veteran and his ex-wife are competent to describe in-service coughing. **See 9/18/2014, STR –Medical, at p. 26; 11/6/2019, Hearing Transcript. Additionally, the examiner is to review and address the Veteran’s submitted medical articles considering silica inhalation and developing sarcoidosis. See 2/09/2021, Correspondence, at 3, 14, and 22.** 3. After completing #1 and #2, obtain an addendum opinion or schedule the Veteran for an examination with an appropriate examiner concerning his heart disabilities. First, identify all heart disabilities, to include after completing any necessary testing during the period on appeal (September 2011 onward). Then, (a.) For each disorder, is it at least as likely as not (50 percent or greater probability) that the Veteran’s disability was caused by a disease or injury in service? (b.) If no, is it at least as likely as not (50 percent or greater probability) that the Veteran’s disability was either 1) proximately due to OR 2) aggravated by any service-connected disability? 4. After completing #1 and #2, obtain an addendum obtain or schedule the Veteran for an examination with an appropriate examiner concerning his kidney disabilities. --First, identify all kidney disabilities during the period on appeal (September 2011 onward), to include after completing any necessary testing. Then, (a.) For each disorder, is it at least as likely as not (50 percent or greater probability) that the Veteran’s disability was caused by a disease or injury in service? (b.) If no, is it at least as likely as not (50 percent or greater probability) that the Veteran’s disability was either 1) proximately due to OR 2) aggravated by any service-connected disability? 5. Lastly, if the Veteran is now service connected for any of the remanded disabilities per the Veterans Benefits Administration (VBA), and any remanded disability is not found to be caused by a disease or injury in service, please address whether the disability: (a.) Is it at least as likely as not (50 percent or greater probability) that any disability was either 1) proximately due to OR 2) aggravated by any service-connected disability? The term “aggravated” refers to a worsening of the underlying condition beyond the natural progression of the disease, as opposed to temporary or intermittent flare-ups or symptoms that resolve with return to the baseline level of disability. If aggravation is found, please state, to the extent possible, the baseline level of disability prior to aggravation. 6. Inform EACH examiner above that a comprehensive rationale for all opinions must be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be provided without resorting to speculation, the examiner must explain why this is so and 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), the record (additional facts are required), or the examiner (does not have the knowledge or training). Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Morales, 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.