Citation Nr: 23009043 Decision Date: 02/10/23 Archive Date: 02/10/23 DOCKET NO. 17-52 548 DATE: February 10, 2023 REMANDED Entitlement to a compensable rating for service-connected sarcoidosis is remanded. Entitlement to an extraschedular total disability rating based on individual unemployability (TDIU) solely due to service-connected sarcoidosis is remanded. REASONS FOR REMAND The Veteran served United States Army on active duty from January 1990 to May 1997 with additional Reserve service. This matter is before the Board of Veterans' Appeals (Board) on appeal from a May 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in New Orleans, Louisiana. The Veteran requested a Board hearing in his September 2019 VA Form 9 but did not attend the August 2021 scheduled hearing and did not request to reschedule or postpone the hearing. Accordingly, the Board will proceed as if the request for the hearing has been withdrawn. 38 C.F.R. § 20.704(d). The Board notes that the Veteran has submitted various statements regarding the characterization of his discharge with the submission of statements regarding the appropriate rating for service-connected sarcoidosis. It has previously been favorably determined that the Veteran's service was honorable for VA purposes. See March 1999 Rating Decision. The Veteran is not required to continue to prove his service was honorable for VA purposes. Additionally, the Veteran has requested that his prostate condition "be considered in this evaluation because upon [his] separation [he] had a healthy one." See February 2019 Statement. There is no indication at this time that the Veteran's prostate condition is related to or a residual of his service-connected sarcoidosis. Therefore, the Veteran's prostate condition is not within the scope of this appeal. If he desires, the Veteran may file a separate claim of service connection for a prostate condition. Lastly, the Veteran last inquired about the state of his claim for an increased rating for status post-hemorrhoidectomy in a December 2022 Report of General Information. A compensable rating for hemorrhoids, status post hemorrhoidectomy, was denied in a May 2022 Board Decision. 1. An increased compensable rating for service-connected sarcoidosis is remanded. A remand is necessary to ensure that there is a complete and accurate record upon which to decide the Veteran's claim so that every possible consideration is afforded. The claims file reflects that the Veteran received community care treatment (VA authorized, non-VA treatment), but these medical records are not within the evidentiary record. See, e.g., June 2022 NonVA Consult Note (reflecting that a May 2022 pulmonary consult was received and scanned into the health file). VA treatment and VA authorized non-VA treatment records must be obtained before final adjudication these issues, regardless of relevance. See Sullivan v. McDonald, 815 F.3d; 786, 790-91 (Fed. Cir. 2016); Turner v. Shulkin, 29 Vet. App. 207, 210 ; see also Jones v. Wilkie, 918 F.3d 922, 926-27 (Fed. Cir. 2019). A remand is required to allow VA to obtain them. There also has not been substantial compliance with the Board's previous remand directives regarding this issue because the August 2022 VA respiratory examination was inadequate. In the May 2022 Board Remand, the Board directed that the examiner "indicate whether, since 2012, the Veteran has or has had, persistent symptoms requiring chronic low dose (maintenance) or intermittent corticosteroids." The August 2022 examiner noted that the Veteran did not require the use of oral or parenteral corticosteroid medications. See August 2022 VA Respiratory Examination. However, during the period under review and since 2012, the Veteran's VA treatment records that his service-connected sarcoidosis was treated with prednisone. See July 2014 Pulmonary Outpatient Note ("Patient had symptoms of persistent night sweats which were impairing his quality of life. Started on Prednisone 40 mg qod."); November 2014 Triage Note ("Finished six month intermittent course of prednisone finised in September"). Accordingly, another remand is required in order to obtain an examination that reflects the entire period at issue, as was directed in the prior Board remand. Stegall v. West, 11 Vet. App. 268, 271 (1998). By remanding on this basis, the Board herein makes no finding as to whether the September 2022 or November 2022 medical opinions are adequate. 2. An extraschedular TDIU solely due to service-connected sarcoidosis is remanded. The record reflects that the Veteran's service-connected disabilities may have prevented him from working during the appeal period. See March 2013 VA Form 21-4138 (Statement of spouse reporting that the Veteran has not worked since separation from service due to the diagnosis of sarcoidosis.); see also August 1999 VA Form 21-8940, Application for Increased Compensation Based on Unemployability (requesting TDIU based on sarcoidosis and a mental condition and reflecting that his last employment was with the Army). Because a TDIU rating is inherent in any claim for an increased rating, see Rice v. Shinseki, 22 Vet. App. 447 (2009), it has been added as an issue. Although the Veteran is in receipt of a 100 percent rating for service-connected psychosis for the entire period under review, the issue of a TDIU due to sarcoidosis is not moot because he is potentially eligible for special monthly compensation (SMC) at the housebound rate. See 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i); see also Buie v. Shinseki, 24 Vet. App. 242, 248 (2011); Bradley v. Peake, 22 Vet. App. 280, 294 (2008). This issue is inextricably intertwined with the Veteran's other remanded issue; accordingly, it must be remanded as well. At this time, a referral to the Director of Compensation Service under 38 C.F.R. § 4.16(b) is not warranted because there is not sufficient evidence to substantiate a reasonable possibility that the Veteran is unemployable due to his sarcoidosis alone. The matters are REMANDED for the following action: The AOJ should obtain copies of VA treatment records from May 2020 to the present. 1. The AOJ should obtain copies of VA treatment records (including records scanned into VistA print, but not available in CAPRI) from November 2022 to the present. 2. The AOJ should obtain copies of all records scanned into VistA print or otherwise scanned into the health record, but not available in CAPRI from prior to November 2022. 3. The AOJ should obtain copies of all medical records for VA-authorized, non-VA medical care (e.g., VA community care or VA Choice). 4. After the development in the directives above is completed, the AOJ should arrange for an examination of the Veteran to assess the severity of his service-connected sarcoidosis dating back to 2012. The examiner should provide a full description of the disability and report all signs and symptoms associated with the Veteran's disability. In particular, the examiner is requested to answer the following questions: (b.) Is it at least as likely as not that the Veteran has or has had persistent symptoms of sarcoidosis (regardless of whether they are pulmonary in nature) requiring the use of corticosteroids since 2012? Please detail the time periods he required the use of corticosteroids since 2012. Please answer this question in the affirmative if the Veteran's symptoms required the use of corticosteroids, but the Veteran was unable to take them due to steroid-induced aggravation of his psychosis. (c.) If the answer to (b) above is "yes," is it at least as likely as not that the Veteran required systemic high dose (therapeutic) corticosteroids for control of his symptoms? Please detail the time periods he required the use of systemic high dose (therapeutic) corticosteroids since 2012. (d.) If the answer to (b) above is "yes," and regardless of whether the answer to (c) above is "yes," is it at least as likely as not that the Veteran required chronic low dose (maintenance) or intermittent corticosteroids. Please detail the time periods he required the use of chronic low dose (maintenance) or intermittent corticosteroids since 2012. "At least as likely as not" is defined as a "likelihood is at least approximately balanced or nearly equal, if not higher." 5. The AOJ should provide the Veteran appropriate notice of VA's duties to notify and assist regarding how to substantiate a claim for entitlement to TDIU, to include providing him a VA Form 21-8940. The Veteran should assist in the matter by providing the requested information. 6. If upon completion of the above action the issues remain denied, the case should be returned to the Board after compliance with appellate procedures. S. F. Keane Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Lambert 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.