Citation Nr: 21042560 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 18-12 150 DATE: July 13, 2021 ORDER The appeal as to the issue of entitlement to service connection for a bilateral hand disorder is dismissed. The appeal as to the issue of entitlement to service connection for vitamin D deficiency is dismissed. Service connection for right ankle strain is granted. Service connection for left ankle strain is granted. Service connection for hypertension is granted. REMANDED Entitlement to service connection for sarcoidosis is remanded. FINDINGS OF FACT 1. At the January 2021 Board hearing, prior to the promulgation of a Board decision, the Veteran withdrew his appeal as to the issues of entitlement to service connection for a bilateral hand disorder and vitamin D deficiency. 2. Resolving all doubt in his favor, the Veteran's current right and left ankle disorders, diagnosed as strains, are related to injuries incurred during his military service. 3. Resolving all doubt in his favor, the Veteran's currently diagnosed hypertension is related to his military service. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the appeal as to the issue of entitlement to service connection for a bilateral hand disorder by the Veteran have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 2. The criteria for withdrawal of the appeal as to the issue of entitlement to service connection for vitamin D deficiency by the Veteran have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 3. The criteria for service connection for right ankle strain have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. 2. The criteria for service connection for left ankle strain have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for hypertension have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty for training from September 1987 to March 1988, and on active duty from November 1988 to November 1992. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in March 2014 by a Department of Veterans Affairs (VA) Regional Office. In January 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. At such time, the Veteran waived Agency of Original Jurisdiction (AOJ) consideration of the evidence received since the January 2018 statement of the case. 38 C.F.R. § 20.1305(c). The undersigned also held the record open for 60 days for the submission of additional evidence, which was received in February 2021. 38 U.S.C. § 7105(e)(1). Withdrawn Claims 1. Entitlement to service connection for a bilateral hand disorder. 2. Entitlement to service connection for vitamin D deficiency. The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 19.55. Withdrawal may be made by the appellant or by his or her authorized representative. Id. At the January 2021 hearing, prior to the promulgation of a decision, the Veteran withdrew his claims for service connection for a bilateral hand disorder and vitamin D deficiency. In this regard, the Board finds that such withdrawal was explicit, unambiguous, and done with a full understanding of the consequences of such action on the part of the Veteran. Acree v. O'Rourke, 891 F.3d 1009 (Fed. Cir. 2018), DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011). Therefore, there remain no allegations of errors of fact or law for appellate consideration with regard to such matters. Accordingly, the Board does not have jurisdiction to review the appeal of such issues and they are dismissed. Service Connection Claims Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996). 3. Entitlement to service connection for a left ankle disorder. 4. Entitlement to service connection for a right ankle disorder. The Veteran contends that he currently has left and right ankle disorders as a result in-service injuries incurred as a result of performing rigorous physical training and playing sports. In this regard, at the January 2021 Board hearing, the Veteran reported that, while he had multiple injuries to each ankle in service, he did not always go to sick call; rather, he self-treated his injuries by using Bengay, wrapping his ankles, and keeping them elevated. He further testified that he has continued to experience pain in the ankles that has continued to the present time. In this regard, the Veteran's service treatment records (STRs) reflect that he received treatment for a left ankle sprain in July 1992 and a right ankle sprain in August 1992, for which he received treatment and profiles. Additionally, while he reported seeking treatment for bilateral ankle complaints immediately after service, such records are not on file. Rather, the first indication of a left or right ankle disorder was in an April 2013 Disability Benefits Questionnaire (DBQ) submitted by the Veteran. Specifically, at such time, his treating physician's assistant, E.P., noted diagnoses of left and right ankle pain with a notation that the Veteran had previous ankle sprains during active duty and has had pain on and off since then. However, no opinion regarding the etiology of the Veteran's right or left ankle was provided. Nonetheless, in light of his in-service treatment for bilateral ankle sprains, the Veteran was afforded a VA examination in October 2013 in order to determine the nature and etiology of his claimed disorders. At such time, the VA examiner diagnosed bilateral ankle strains, and noted the Veteran's report that he sprained both ankles on separate occasions while playing sports in the military and such had never fully recovered. However, he opined that he could not opine whether the Veteran's current bilateral ankle strain is caused or aggravated by his military service without resorting to mere speculation. In this regard, he noted that, while the Veteran was treated for left and right ankle sprains in service, they were included in the minor temporary problem list and his separation examination is silent for any ankle or joint problems. Therefore, the examiner found that there is no current objective evidence that the Veteran's bilateral ankle injuries documented in service were more than acute and transitory events, or that these events or injuries could have caused or aggravated, to any degree, his current bilateral ankle strain. Conversely, in October 2018, E.P., the Veteran's private treating physician's assistant, opined that, following a review of the Veteran's STRs, which reflected multiple notes of ankle injuries, and his private treatment records, his bilateral ankle condition as likely as not resulted from his military service. In January 2021, E.P. provided another opinion in which he stated that it is at least as likely as not that the Veteran's bilateral ankle disorder was caused by or the result of his military service. In this regard, he noted that the Veteran had been a patient since 1993, he had reviewed the STRs, and he had taken an extensive history from the Veteran. Thereafter, he noted that the Veteran's STRs reflected ankle injuries that show the use of splints, crutches, duty profiles, and limiting the weight put on his ankles. E.P. stated that the long term results of repeated injuries on the ankles can cause chronic pain, weakened strength, and arthritis. Thus, he concluded that the Veteran's bilateral ankle disorder is at least as likely as not related to service. Upon review, the Board finds that the evidence as to whether the Veteran's currently diagnosed bilateral ankle strains are related to his military service to be in equipoise. In this regard, the October 2013 VA examiner and E.P. are both medical professionals, considered all relevant facts and medical principles, and offered a rationale for their opinions. Consequently, the Board resolves all doubt in the Veteran's favor and finds that current right and left ankle disorders, diagnosed as strains, are related to injuries incurred during his military service. Thus, service connection for such disorders is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 5. Entitlement to service connection for hypertension. The Veteran contends that his current hypertension had its onset in service. Specifically, at his January 2021 Board hearing, he testified that he had elevated blood pressure readings on multiple occasions during service and, while he was not treated for it in service, he was advised by the physician who completed his September 1992 separation examination to follow-up with his treatment provider. In this regard, the Veteran's STRs reflect occasional elevated blood pressure readings, to include 130/80 in June 1989, 150/80 in May 1990, 148/94 in January 1992, 144/84 in July 1992, 133/81 in August 1992, and 141/70 in September 1992, and his September 1992 separation examination reflects a notation for him to follow up due to an elevated blood pressure reading. Additionally, while he reported seeking treatment immediately after service, such records are not on file. Rather, the first indication of hypertension was in an February 2013 DBQ submitted by the Veteran. Specifically, at such time, his treating physician's assistant, E.P., noted a diagnosis of hypertension with a history of sustained elevated blood pressure readings in August 2004, which resulted in the prescription for medication. Additionally, in October 2018, E.P. noted that the Veteran had several notations of high blood pressure readings during service and was advised to follow up due to an elevated blood pressure reading at his separation examination. He further noted that he was currently being treated for hypertension, and opined that such disorder likely as not resulted from his military service. In January 2021, E.P. provided another opinion in which he stated that it is at least as likely as not that the Veteran's hypertension was caused by or the result of his military service. In this regard, he noted that the Veteran had been a patient since 1993, he had reviewed the STRs, and he had taken an extensive history from the Veteran. Thereafter, he noted that the Veteran's STRs reflected numerous notations of high blood pressure that were not treated while in service, and he was advised to follow up for elevated blood pressure on his separation examination. Consequently, as E.P., is a medical professional, considered all relevant facts and medical principles, and offered a rationale for his opinion, and there is no medical opinion to the contrary, the Board resolves all doubt in the Veteran's favor and finds that his currently diagnosed hypertension is related to his military service. Thus, service connection for such disorder is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. REASONS FOR REMAND 6. Entitlement to service connection for sarcoidosis. The Veteran asserts that his currently diagnosed sarcoidosis had its onset during, or is otherwise related to, his military service. Specifically, at the January 2021 Board hearing, he testified that, while his STRs are negative for such a diagnosis, he believed he was treated for ailments that were indicative of the initial manifestations of sarcoidosis, to include shortness of breath and wheezing, during service. He also indicated that his physician indicated that such disorder may be due to environmental exposure during his service in Korea. In this regard, his STRs reflect treatment for complaints of wheezing, with a diagnosis of reactive airway disease and prescription for an inhaler, in January 1989, and treatment for a diagnosis of pharyngitis in August 1991. Further, the Veteran's service personnel records reflect service in Korea from April 1990 to August 1991. While the Veteran reported seeking treatment for respiratory complaints immediately after service with a diagnosis of sarcoidosis rendered in 1993, such records are not on file. Rather, the first indication of such disorder was in a December 2012 treatment record. In this regard, it was noted that the Veteran reported a history of mediastinoscopy with a lymph node biopsy in 1993 or 1994 and, while such records were unavailable, the Veteran indicated that, at such time, he was told that he had sarcoidosis where he had adenopathy. Thus, in light of the foregoing, the Board finds that a remand is necessary in order to afford the Veteran a VA examination so as to determine the nature and etiology of the Veteran's sarcoidosis. The matter is REMANDED for the following action: Afford the Veteran an appropriate VA examination to assess the nature and etiology of his sarcoidosis. The record, to include a copy of this Remand, must be made available to the examiner, and all indicated tests and studies should be accomplished. Thereafter, the examiner should address the following inquiries: (A) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's sarcoidosis had its onset in, or is otherwise related to, his military service, to include his allegation that he was treated therein for ailments that were indicative of the initial manifestations of sarcoidosis, to include reactive airway disease in January 1989 and pharyngitis in August 1991, and/or his exposure to environmental hazards while serving in Korea from April 1990 to August 1991? (B) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's sarcoidosis manifested within one year of separation from service in November 1992, i.e., by November 1993? If so, please describe the manifestations. In offering the foregoing opinions, the examiner should consider the Veteran's report that he was diagnosed with sarcoidosis in 1993 or 1994, and the December 2012 private treatment record similarly reflecting such history. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Waite 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.