Citation Nr: 22016803 Decision Date: 03/23/22 Archive Date: 03/23/22 DOCKET NO. 17-54 633 DATE: March 23, 2022 REMANDED Entitlement to service connection for sarcoidosis is remanded. Entitlement to service connection for sleep apnea, to include as due to sarcoidosis, is remanded. REASONS FOR REMAND The Veteran had active air service from March 1986 to March 1990, and subsequent service in the Air Force Reserves and Air National Guard. This case comes before the Board of Veterans' Appeals (Board) on appeal of an August 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran was scheduled for a Board hearing in November 2019; however, he failed to report to it. He has not provided good cause for his failure to appear or requested to reschedule the hearing. Therefore, his hearing request has been deemed withdrawn. In this case, the Veteran asserts that his sarcoidosis was incurred in or is related to his active service. Additionally, he asserts that his sleep apnea is secondary to sarcoidosis and/or his service-connected testicular cancer. A July 1988 service treatment record (STR) indicated that the Veteran's reported having a history of central chest pain that increased with movement and deep breathing. At that time, he was diagnosed with costochondritis. Additionally, reports of medical history from April 1993, October 1997, and May 2002 noted the Veteran's complaints of pain or pressure in his chest and sinusitis. In January 2004, the Veteran's polysomnography results revealed severe sleep apnea. Further, an October 2006 health history questionnaire noted the Veteran's biopsy of the chest in January 2006 and his diagnosis of sarcoidosis. In May 2014, the Veteran submitted a private disability benefits questionnaire (DBQ) for respiratory conditions. At that time, the Veteran was noted as having a diagnosis of chest pain and sarcoidosis. The Veteran also submitted a private DBQ for sleep apnea in May 2014, which noted that he presented in 2003 for snoring and daytime somnolence. In his October 2017 substantive appeal, the Veteran reported that he had severe pains and shortness of breath during active duty. He also indicated that he believed his emergency room visit in July 1988 was his first flare of sarcoidosis, and that it was misdiagnosed as costochondritis. In addition, he stated that he was known for snoring in basic training and that his snoring had been treated as asthma and an allergy condition. Further, he asserted that his sleep apnea was aggravated by his chest pain and related asthma. Based on the foregoing, the Board finds that the Veteran should be afforded a VA examination to determine the nature and etiology of his sarcoidosis and sleep apnea. See 38 C.F.R. § 3.159(c)(4); see also McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: 1. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claims file. 2. Then, schedule the Veteran for a VA examination to determine the nature and etiology of any currently present sarcoidosis. The claims file must be made available to, and reviewed by, the examiner. Based on the examination results and review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present sarcoidosis began during or is otherwise related to the Veteran's active service. In forming this opinion, the VA examiner must specifically address the Veteran's July 1988 diagnosis of costochondritis and his history of chest pain. Specifically, the examiner must address the Veteran's assertion that the symptoms he had in July 1988 were related to sarcoidosis and that his symptoms were misdiagnosed as costochondritis. 3. Then, schedule the Veteran for a VA examination to determine the nature and etiology of any currently present sleep apnea. The claims file must be made available to, and reviewed by, the examiner. Based on the examination results and a review of the record, the examiner should provide the following opinions: (a.) Whether it is at least as likely as not (50 percent or better probability) that any currently present sleep apnea began during or is otherwise related to the Veteran's active service. In forming this opinion, the examiner must address the Veteran's statements that he snored in basic training, and that his snoring was treated as allergies and asthma. (b.) Whether it is at least as likely as not that any currently present sleep apnea was caused or aggravated (chronically worsened) by any currently present sarcoidosis. In forming this opinion, the examiner must address the Veteran's statements that his sleep apnea was aggravated by his chest pain. (c.) Whether it is at least as likely as not that any currently present sleep apnea was caused or aggravated (chronically worsened) by the Veteran's service-connected testicular cancer. 4. Ensure that the VA examination reports and opinions provided comport with this remand, and undertake any other development found to be warranted. 5. Then, readjudicate the remaining issues on appeal. If a decision remains adverse to the Veteran, issue a supplemental statement of the case and allow appropriate time for response. Then, return the case to the Board. SONJA A. MISHALANIE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Byrd, 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.