Citation Nr: 23013545 Decision Date: 03/07/23 Archive Date: 03/07/23 DOCKET NO. 18-35 422 DATE: March 7, 2023 ORDER Entitlement to service connection for sarcoidosis is granted. REMANDED Entitlement to service connection for benign prostatic hypertrophy is remanded. Entitlement to service connection for a skin condition is remanded. FINDING OF FACT The Veteran's sarcoidosis is related to his active duty service. CONCLUSION OF LAW The criteria for service connection for sarcoidosis are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1967 to September 1971 and from September 1973 to September 1989, with service at the Korat Royal Thai Air Force Base (RTAFB) in Thailand from September 1968 to July 1969. The Veteran's claim was previously before the Board in July 2019 but was remanded for further development. Specifically, the AOJ was instructed to develop information regarding whether the Veteran's military occupational specialty would have taken him near the fence line while stationed at Korat RTAFB. The required development was completed and associated with the claims file in February 2020. Accordingly, the Board finds there has been substantial compliance with the remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for sarcoidosis is granted Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. 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). In order to establish service connection for the claimed disability, there must 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) medical, or in certain circumstances, lay evidence of a nexus between the claimed in-service disease or injury and the current disability. See 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The Veteran has been diagnosed with sarcoidosis, as noted at his December 2015 VA respiratory conditions examination. He reported that his symptoms began in 1974 with a dry cough and runny nose, with widespread lesions on his scalp, arms, back, and legs. The December 2015 VA examiner concluded that there was "no evidence" to support the claim that the rash the Veteran had in service was indicative of sarcoidosis and to provide an opinion would require "mere speculation." This is an inadequate medical opinion and is afforded no probative weight. In February 2016, a VA examiner stated that sarcoidosis is not caused by sexually transmitted diseases or treatment for syphilis, but did not explain why. This opinion is also inadequate and is afforded no probative weight. In March 2018, a VA examiner opined that the Veteran had pityriasis rosea in 1994, and that it is less likely that this was the beginning of cutaneous sarcoid as the Veteran served for another 15 years without recurrence of this condition. The examiner stated that the Veteran was seen multiple times between 1987 and 1989 for seborrheic dermatitis and eczema, and was diagnosed with cutaneous sarcoidosis in 1996, seven years after leaving service. The examiner concluded that the Veteran's sarcoidosis, which was "currently stable and asymptomatic," was not related to service. This opinion is well reasoned and provides negative evidence against the claim. The Veteran's private physician submitted a nexus opinion dated December 2014 in which he noted a July 1974 treatment record that indicated a two or three week history of pruritic eruption and stated that it appeared that the etiology of this persistent process was elucidated on punch biopsy specimens obtained from the upper back and posterior scalp on January 23, 1996, which demonstrates a non-caseating granulomatous dermatitis, which is the inflammatory pattern associated with sarcoidosis. For this reason, the physician concluded that the Veteran's sarcoidosis symptoms began during his period of active duty. This opinion is also well reasoned and it supports the Veteran's claim. The persuasiveness of the positive and negative medical opinions is evenly balanced or approximately so with regard to whether service connection for sarcoidosis is warranted. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore applicable to this claim. Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021) (en banc). Service connection for sarcoidosis is granted. REASONS FOR REMAND 1. Entitlement to service connection for benign prostatic hypertrophy 2. Entitlement to service connection for a skin condition The Veteran claims that his prostate condition and skin condition are related to exposure to herbicides while serving in Thailand at the Korat RTAFB from September 1968 to July 1969. During his January 2018 decision review officer (DRO) hearing, the Veteran testified that he worked on the flight line near the perimeter on the fence line. VA regulations provide that a veteran who had active military, naval, or air service in the Republic of Vietnam during the Vietnam Era shall be presumed to have been exposed to herbicides unless there is affirmative evidence to establish that the veteran was not exposed. 38 C.F.R. § 3.307(a)(6)(iii). The Veteran's service personnel records note service at Korat Royal Thai Air Force Base from September 1968 to July 1969. The President and Congress have recently enacted the Honoring our PACT Act of 2022, which extends the presumption of herbicide exposure to veterans who served at any United States or Royal Thai base in Thailand between January 9, 1962 and June 30, 1976. Pub. L. 117-168 (to be codified at 38 U.S.C. § 1116(d)(2)). The Board therefore presumes that the Veteran was exposed to herbicide agents. Although the Veteran's skin and prostate conditions are not on the list of conditions under the regulations for presumptive service connection, service connection may still be warranted with proof of direct actual causation. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). At present, the evidence of record does not contain a VA medical opinion regarding whether the Veteran's benign prostatic hypertrophy and skin condition is related to his exposure to herbicides, to include Agent Orange. VA medical opinions discussing the etiology of the Veteran's benign prostatic hypertrophy and skin condition are necessary to comprehensively evaluate the Veteran's claims for service connection. Accordingly, the matters are REMANDED for the following action: 1. Schedule the Veteran for an examination with an appropriate clinician for his benign prostatic hypertrophy. The examiner must provide an opinion as to whether the Veteran's benign prostatic hypertrophy began during active service, or is related to an incident of service, including exposure to herbicides. The examiner is advised that the Veteran's exposure to herbicides, to include Agent Orange, is acknowledged by the VA. A negative opinion cannot be based on the fact that benign prostatic hypertrophy is not on the list of conditions presumptively associated with exposure to herbicide agents. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 2. Schedule the Veteran for an examination with an appropriate clinician for his skin condition. The examiner must provide an opinion as to whether the Veteran's skin condition began during active service, or is related to an incident of service, including exposure to herbicides. The examiner is advised that the Veteran's exposure to herbicides, to include Agent Orange, is acknowledged by the VA. A negative opinion cannot be based on the fact that the Veteran's skin condition is not on the list of conditions presumptively associated with exposure to herbicide agents. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 3. After all completed development, the AOJ should then readjudicate the claims. If the benefits sought on appeal are not granted, the Veteran and his representative should be provided a Supplemental Statement of the Case and afforded the requisite opportunity to respond before the case is returned to the Board. D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Riordan, 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.