Citation Nr: 23002575 Decision Date: 01/15/23 Archive Date: 01/15/23 DOCKET NO. 17-21 002 DATE: January 15, 2023 REMANDED Entitlement to an initial rating greater than 10 percent for sarcoidosis is remanded. REASONS FOR REMAND The Veteran had active service from February 1978 to July 1981. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2017 rating decision of an Agency of Original Jurisdiction (AOJ) of the U.S. Department of Veterans Affairs (VA). The Veteran testified before the undersigned in December 2021. A transcript of the hearing is in the claims file. In May 2022, the Board remanded this appeal for additional development. Specifically, it ordered a VA examination because the Veteran testified that his symptoms had worsened since his prior VA examination. As part of this examination, the Board ordered inquiry into whether the Veteran's emphysema is related to his sarcoidosis. In October 2022, the AOJ examined the Veteran. The examiner addressed the questions the Board posed regarding the emphysema. Therefore, the Board finds the AOJ substantially complied with this aspect of the May 2022 Remand. However, it did not comply in another respect. The AOJ rates the Veteran's sarcoidosis under 38 C.F.R. § 4.97 using a hyphenated Diagnostic Code, i.e., 6846-6600. Under Diagnostic Code 6846, a noncompensable rating contemplates chronic hilar adenopathy or stable lung infiltrates without symptoms or physiologic impairment. Diagnostic Code 6846 does not provide a 10 percent rating. Sarcoidosis with pulmonary involvement with persistent symptoms requiring chronic low dose (maintenance) or intermittent corticosteroids is rated 30 percent disabling. Sarcoidosis with pulmonary involvement requiring systemic high dose (therapeutic) corticosteroids for control is rated 60 percent disabling. Sarcoidosis with cor pulmonale, or; cardiac involvement with congestive heart failure, or; progressive pulmonary disease with fever, night sweats, and weight loss despite treatment, is rated 100 percent disabling. Diagnostic Code 6846 indicates that active disease or residuals may otherwise be rated as chronic bronchitis (Diagnostic Code 6600) and extra-pulmonary involvement under the specific body system involved. Under Diagnostic Code 6600, a 10 percent rating is warranted for the Forced Expiratory Volume in one second (FEV-1) of 71- to 80-percent predicted, or; the ratio of Forced Expiratory Volume in one second to Forced Vital Capacity (FEV-1 /FVC) of 71 to 80 percent, or; Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) 66- to 80-percent predicted. A 30 percent rating is warranted for the FEV-1 of 56- to 70-percent predicted, or; the FEV-1 /FVC of 56 to 70 percent, or; DLCO (SB) of 56- to 65-percent predicted. A 60 percent rating is warranted for FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; DLCO (SB) 40- to 55-percent predicted; or maximum oxygen consumption of 15 to 20 ml/kg/min (with cardiorespiratory limit). The Board highlights the rating criteria because the August 2022 VA examination report is incomplete as it does it contain the DLCO readings responsive to the Diagnostic Code 6600 criteria. While the August 2022 VA examiner noted that DLCO testing was not indicated for the Veteran's condition, the prior November 2016 VA examination found it was. Therefore, the Board must order a new VA examination to clarify and obtain the DLCO readings, if indicated for the Veteran's condition. The matters are REMANDED for the following action: 1. Schedule a VA examination to determine the nature and severity of the Veteran's sarcoidosis. In addition to the customary examination/disability benefits questionnaire, ensure that all information required by both Diagnostic Code 6846 and Diagnostic Code 6600 is included in the examination report. If DLCO testing is not performed, the examiner should explain why not and clarify what has changed in the Veteran's condition since the November 2016 VA examination which did provide DLCO results. Tiffany Dawson Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Sopko, 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.