SARCOIDOSIS

M. PRYCE · 2026 · Case ID: 26004171

DENIED

Summary

The veteran, who served from March 1971 to December 1972, including service in the Republic of Vietnam, appeals the denial of service connection for sarcoidosis. The case has a complex procedural history involving multiple remands from the U.S. Court of Appeals for Veterans Claims. The veteran claims sarcoidosis, attributing it to his service. The Board reviewed extensive medical evidence, including VA and private treatment records dating back to 1977, as well as multiple VA examinations conducted between 2007 and 2026. While some early records (1977) suggested a differential diagnosis of sarcoid, and the veteran reported a diagnosis in 1977 or 1981, subsequent examinations and current imaging consistently showed normal lungs and no objective evidence or diagnosis of sarcoidosis or any other chronic respiratory condition. The most persuasive evidence, particularly the October 2025 examination and January 2026 addendum, concluded that the veteran does not have sarcoidosis or any active pulmonary condition, citing normal diagnostic testing and the lack of objective findings or treatment for the condition. The Board found the veteran's lay statements regarding a past diagnosis competent but not persuasive of a current disability, especially given the lack of supporting medical evidence. The benefit-of-the-doubt doctrine was considered but found inapplicable as the evidence weighed against the claim. Service connection for sarcoidosis was denied.

Rationale

No current diagnosis of sarcoidosis or chronic respiratory condition; Early records indicated a differential diagnosis, not a confirmed diagnosis; Most persuasive evidence (2025/2026 exams) found no objective evidence or diagnosis

Special Benefit

NO SPECIAL BENEFIT

Docket No.

17-41 054

Full Decision Text

Citation Nr: 26004171
Decision Date: 04/03/26 Archive Date: 04/03/26

DOCKET NO. 17-41 054
DATE: April 3, 2026

ORDER

Entitlement to service connection for sarcoidosis is denied.

FINDING OF FACT

The evidence of record persuasively weighs against finding that the Veteran has had sarcoidosis or any other related respiratory or pulmonary disability at any time during or approximate to the pendency of the claim.

CONCLUSION OF LAW

The criteria for entitlement to service connection for sarcoidosis have not been met. 38 U.S.C. §§ 1110, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from March 1971 and December 1972, with service in the Republic of Vietnam.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a March 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO), the Agency of Original Jurisdiction (AOJ). This matter comes before the Board subject to the Legacy system of review.

This appeal has a long and complicated history. In February 2020, the Veteran testified at a Board hearing before a Veterans Law Judge. In May 2020, the Board denied, among other things, claims for service connection of sarcoidosis and a skin condition. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court), and in March 2021, the Court issued a Joint Motion for Partial Remand (JMPR), which vacated (among other things) the skin and sarcoidosis claims.

In September 2021, the Board issued a remand in compliance with the instructions of the Court in the JMPR. In September 2022, VA notified the Veteran that the Judge who had conducted his hearing was no longer employed at the Board. The Veteran indicated that he did not wish to appear for a new hearing. In November 2022, the Board issued a new remand to ensure compliance with its prior remand orders.

In April 2024, the Board issued a decision which, among other things, denied service connection of a skin condition and sarcoidosis. The Veteran again appealed that decision to the Court, and in May 2025, the Court issued a Joint Motion for Remand (JMR), which again vacated the skin and sarcoidosis claims, returning them to the Board.

In September 2025, the Board issued a remand in compliance with the Court's instructions in the JMR. The claim for service connection of sarcoidosis is now returned to the Board for further appellate review.

In January 2026, the AOJ issued a rating decision which granted service connection for stasis dermatitis and assigned a noncompensable rating for that disability. This constitutes a complete grant of the benefit sought as part of the skin disability claim. As such, the claim for service connection of a skin disability is no longer part of this appeal.

Service Connection

Service connection may be granted for a disability resulting from disease or injury

incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110;

38 C.F.R. § 3.303(a). Service connection may 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). As a

general matter, service connection for a disability requires evidence of: (1) the

existence of a current disability; (2) the existence of the disease or injury in

service, and; (3) a relationship or nexus between the current disability and any

injury or disease during service. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir.

2004). All three elements must be satisfied before direct service connection may be achieved.

Service connection may also be established for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 U.S.C. §§ 1113(b); 38 C.F.R. § 3.303(d).

2004). All three elements must be satisfied before direct service connection may be achieved.

In addition, certain chronic diseases, including sarcoidosis, may be presumed to have been incurred during service if the disorder becomes manifest to a compensable degree within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013). Regardless of whether a condition is listed as chronic for presumptive purposes, a continuity of symptoms from the time of service is a factor to consider in assessing any claim.

Further, if a veteran was exposed to a herbicide agent during active military, naval, or air service in Vietnam, then certain diseases shall be service connected even though there is no record of such disease during service. For the purposes of this section, the term "herbicide agent" means a chemical in a herbicide used in support of the United States and allied military operations in the Republic of Vietnam during the Vietnam era. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6), 3.309(e), 3.313. Notably, sarcoidosis is not listed amongst those diseases for which presumptive service connection is granted due to herbicide exposure. However, the availability of presumptive service connection for a disability based on

exposure to herbicide agents does not preclude a veteran from establishing service

connection with proof of direct causation, or on any other recognized basis. See

Stefl v. Nicholson, 21 Vet. App. 120 (2007); see also Combee v. Brown, 34 F.3d

1039 (Fed. Cir. 1994).

1. Entitlement to service connection for sarcoidosis

The Veteran is seeking service connection for sarcoidosis which he attributes to active service.

The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110. Even in the absence of a diagnosed disability, evidence of functional limitations due to symptoms can meet this requirement. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Specifically, in Saunders, the Federal Circuit found that the term "disability," as used in 38 U.S.C. § 1110 refers to the functional impairment of earning capacity, not the underlying cause of said disability, and held that pain alone can serve as a functional impairment and therefore qualify as a disability.

The Board finds that the Veteran does not have, nor has he had during the appeal period in question, a chronic respiratory or pulmonary disability - to include sarcoidosis - which can be linked to active service.

Initially, the Board recognizes that this appeal has a long and complicated procedural history, which has resulted in multiple examinations and the compiling of many years of medical records.

The Veteran filed his claim for service connection of sarcoidosis in November 2011. VA and private treatment records dating back to 1977 are included in the Veteran's electronic claims file. The Board notes that these records have been fully reviewed and considered. These records contain a July 1977 radiographic report of a differential diagnosis of sarcoid with additional imaging advisable. Here, the Board notes that the definition of differential diagnosis is "the distinguishing of a disease or condition from others presenting with similar signs and symptoms." Mirriam-Webster Dictionary, Differential Diagnosis, https://www.merriam-webster.com/dictionary/differential%20diagnosis (last accessed April 1, 2026).

Records available during the initial development of the appeal did not confirm any diagnosis of sarcoidosis or other chronic respiratory condition contemporary appeal period. For example, in August 2012, VA medical treatment records showed a respiratory system "clear to subcultation." At that time, he was noted to have obstructive sleep apnea, and that he had been tested for sarcoidosis (as self-reported by the Veteran),
definition of differential diagnosis is "the distinguishing of a disease or condition from others presenting with similar signs and symptoms." Mirriam-Webster Dictionary, Differential Diagnosis, https://www.merriam-webster.com/dictionary/differential%20diagnosis (last accessed April 1, 2026).

Records available during the initial development of the appeal did not confirm any diagnosis of sarcoidosis or other chronic respiratory condition contemporary appeal period. For example, in August 2012, VA medical treatment records showed a respiratory system "clear to subcultation." At that time, he was noted to have obstructive sleep apnea, and that he had been tested for sarcoidosis (as self-reported by the Veteran), but no confirmed diagnosis was given nor any other respiratory disorder confirmed. Records from January 2010 showed respiration that was even and unlabored with no diagnosis of any respiratory disability. In June 2007, he did not have any respiratory issues reported on physical examination.

Private treatment records submitted in January 2016 showed a report of painful breathing with onset in October 2013, but no associated diagnosis. A January 2016 physical examination showed no dyspnea; no dullness, flatness or hyperresonance on percussion; no wheezing, rales, crackles, or rhonchi; normal breath sound with good air movement, and no reason for imaging. No respiratory diagnosis was provided at that time. Prior private records show similar findings without any diagnosis of sarcoidosis or other chronic respiratory condition.

In March 2022, the Veteran was afforded an in-person respiratory conditions examination. At that time, the examiner conducted a physical examination of the Veteran and reviewed all available medical records. The examiner noted a diagnosis of sarcoidosis, as reported by the Veteran, which was diagnosed in 1977, with bronchoscopy and biopsy of the lungs in 1981. However, the condition was noted to have stayed the same since that time and did not require medical treatment. A December 2021 chest x-ray was reviewed and showed normal lungs.

A medical opinion offered at that time found the Veteran to be credible regarding breathing issues during active service but stated that sarcoidosis was not diagnosed in service and there is no documentation of findings for which such a diagnosis can be made. The diagnosis reported by the Veteran was given many years after service. As regards pulmonary sarcoidosis, a "note must be made that the chest x-rays remain to this day normal." Further notations indicated that, even though there was notation of sarcoidosis in the record many years prior, it was a single episode and there was no evidence of any such condition now. Current x-rays are normal and to the extent that he has any hilar adenopathy, it is asymptomatic.

In September 2023, the Veteran was afforded a new VA examination. The examiner conducted a physical examination of the Veteran, including pulmonary testing, and concluded that the Veteran does not have a current diagnosis of any respiratory condition, to include sarcoidosis. In support of this non-diagnosis, the examiner stated that in most patients, a definitive diagnosis of sarcoidosis requires a biopsy to determine whether granulomas are present. Such diagnostic testing, as reported by the Veteran, was not found in the record. The Veteran's x-rays were normal during his most recent examination and did not show any information related to sarcoidosis. As such, no diagnosis was rendered during the examination.

An addendum was offered to that examination in October 2023. A new examiner reviewed the evidence of record and stated that the Veteran does not have a pulmonary condition. In support of this, the examiner noted that, a thorough review of the file, no evidence of any testing, as reported by the Veteran confirming mild sarcoidosis, could be found. As such, there was no change to the opinion of the September 2023 examiner that the Veteran did not have a pulmonary condition. A further addendum opinion was offered in November 2023, which opined against service connection of sarcoidosis, but relied on the premise that the condition was active and had been diagnosed in 1981. It did not explicitly discuss the question of a current diagnosis.

In December 2023, a new VA examination report diagnosed sarcoidosis with a date of onset in 1977. A medical history was given as reported by the Veteran and noted sinusitis and tenderness around the eyes. He also reported occasional short breath with exertion and used flonase daily. Notably, pulmonary function testing at that time was normal.

In October 2025, a new VA examination was conducted, which included a physical examination and pulmonary function testing. At that time, he had
ined against service connection of sarcoidosis, but relied on the premise that the condition was active and had been diagnosed in 1981. It did not explicitly discuss the question of a current diagnosis.

In October 2025, a new VA examination was conducted, which included a physical examination and pulmonary function testing. At that time, he had a normal chest x-ray, and normal spirometry. The examiner explicitly stated that the Veteran does not have a current diagnosis associated with any claimed respiratory conditions. The examiner took a detailed medical history from the Veteran, including his report of having a biopsy in 1981 and being told he had sarcoidosis, which had stayed the same since that time. He had not had any treatment or surgeries for this condition. He did not require medical treatment for a respiratory condition. The examiner noted normal chest x-rays in October 2025 and December 2021. He had normal pulmonary functioning testing. There was no functional impact of any respiratory kind. The examiner stated that the 2022 diagnosis was made in error and without any specific testing to support such a diagnosis, one could not be made at that time.

In January 2026, an addendum opinion was offered which again stated that the Veteran does not have sarcoidosis or any other respiratory condition. The examiner stated that there is no objective evidence of such a diagnosis and that the December 2023 diagnosis was made in error. The examiner noted a history of chronic colds at entrance to service. He had a normal respiratory examination upon separation. Sarcoidosis was not noted on his new patient examination with VA in August 2007. Subsequent treatment records left it out as an active pathology. He was occasionally treated for cough or dyspnea, but no actual diagnosis of any chronic respiratory condition. The examiner cited to a medical text and noted that a diagnosis of sarcoidosis requires three criteria be met: compatible clinical presentation, findings of non-caseating granulomatous inflammation in more or more tissue samples, and exclusion of alternative causes of granulomatous disease or diseases capable of producing similar clinical pictures. These criteria had not been met. He noted that the diagnoses in either 1977 or 1981 were by report of the Veteran and lacked medical documentation to confirm. He had completely normal diagnostic testing throughout the appeal period, and therefore any prior diagnoses given were made in error. Indeed, the medical evidence of record did not support the diagnosis of any respiratory condition.

"Competent medical evidence" means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also mean statements conveying sound medical principles found in medical treatises. It would also include statements contained in authoritative writings such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159 (a).

The Court has instructed that, in order for a medical opinion (i.e., medical evidence) to be given weight, it must be: (1) based upon sufficient facts or data; (2) be the product of reliable principles and methods; and (3) be the result of principles and methods reliably applied to the facts. See Nieves-Rodriquez v. Peake, 22 Vet. App. 295, 302 (2008).

Ultimately, the Board finds the October 2025 examination and January 2026 addendum to be most persuasive of the question of whether or not the Veteran has a chronic pulmonary condition which can be connected to active service. Those opinions were given following physical examination and pulmonary functioning testing, as well as chest imaging. Further, the January 2026 addendum opinion included a thorough review of the evidence of record and provided a detailed explanation of why no such diagnosis could be supported. It relied on known medical principles and cited to medical treatise evidence to support the conclusion reached that the Veteran does not have an active disability.

Further, these conclusions are supported by the September 2023 examination and October 2023 addendum which also relied on physical examination of the Veteran and medical testing to conclude at that time that no such diagnosis could be offered.

The Board does acknowledge that the March 2022 and December 2023 examination reports give a diagnosis of sarcoidosis with a date of onset in 1977. However, upon review, those conclusions are based on a
2026 addendum opinion included a thorough review of the evidence of record and provided a detailed explanation of why no such diagnosis could be supported. It relied on known medical principles and cited to medical treatise evidence to support the conclusion reached that the Veteran does not have an active disability.

The Board does acknowledge that the March 2022 and December 2023 examination reports give a diagnosis of sarcoidosis with a date of onset in 1977. However, upon review, those conclusions are based on a medical history as reported by the Veteran and rely on the fact that the diagnosis was actually confirmed at that time. However, to the extent that the 1977 records do give a reference of "sarcoid," that diagnosis was differential and additional imaging was suggested, so it is unclear as to whether that condition was ever actually given a confirmed diagnosis, and this fact was not discussed in either examination report or associated opinion. Further, the March 2022 examination report was undercut by the addendum opinion offered at the same time which noted a single report many years prior, but that the medical evidence available at this time cannot confirm any such diagnosis.

Ultimately, when weighing the contradictory medical evidence of record, the Board finds the 2025 and 2026 examination and opinion to be the most persuasive, with support from the September and October 2023 examination and addendum, as well as the March 2022 addendum. This evidence was based on complete review of the file, consideration of the Veteran's own reported history, and applied the facts in evidence to reliable medical principles and methods to conclude that no such diagnosis is present. They are also supported by the lack of any such diagnosis in the Veteran's contemporary treatment records throughout the appeal period. The March 2022 and December 2023 examination reports are less persuasive because they do not provide specific analysis of how such diagnoses were reached and appear to rely exclusively on the reported history given by the Veteran.

The Board does acknowledge the Veteran's own statements and assertions that he was diagnosed with sarcoidosis in either 1977 or 1981. To the extent that the Veteran is capable of reporting such a diagnosis as specifically given to him by a medical professional at that time, he is competent to provide this evidence. Layno v. Brown, 6 Vet. App. 465, 471 (1994). However, as a lay person, he is competent to report observable symptoms of an illness, but not provide a specific diagnosis, especially in a situation where a diagnosis would require specific medical testing. Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007); see also Layno v. Brown, 6 Vet. App. 465, 469-71 (1994) (noting that a Veteran's testimony that he had bronchial asthma was not competent; however, testimony of symptoms of difficulty breathing is competent).

Further, once basic competency is met, the Board must consider credibility of the evidence. See Caluza v. Brown, 7 Vet. App. 498 (1995).

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In this case, the Board does not discount that the Veteran was told he had a diagnosis of sarcoidosis over 40 years ago. However, even presuming that such evidence is competent and credible, it only speaks to a diagnosis made many years prior to when he filed his claim of service connection. Those statements have been mostly consistent throughout the appeal. However, those statements do not confirm or even provide indication of such a diagnosis during the period on appeal, meaning from the date he filed his claim for service connection in 2011. For his part, the Veteran testified in his hearing that he was diagnosed between 1977 and 1981, and told he had a sarcoid, but when questioned if it had been chronic since that time, he stated that it was his understanding that once you have it, it does not go away. He did not testify to any respiratory or pulmonary symptoms present at the time of the hearing or during any period on appeal, and the medical evidence of record does not support that he has had a chronic respiratory condition throughout the appeal period. As such, the Board does not find his lay statements to be persuasive of a current disability.

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In sum, the Board has carefully reviewed all evidence of record and must conclude that the evidence and opinions do not support a finding of a currently diagnosed disability or symptoms of a disability which would result in occupational impairment. Rather, the most persuasive evidence of
since that time, he stated that it was his understanding that once you have it, it does not go away. He did not testify to any respiratory or pulmonary symptoms present at the time of the hearing or during any period on appeal, and the medical evidence of record does not support that he has had a chronic respiratory condition throughout the appeal period. As such, the Board does not find his lay statements to be persuasive of a current disability.

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In sum, the Board has carefully reviewed all evidence of record and must conclude that the evidence and opinions do not support a finding of a currently diagnosed disability or symptoms of a disability which would result in occupational impairment. Rather, the most persuasive evidence of record supports the conclusion that the Veteran does not have a diagnosis of sarcoidosis or any other chronic pulmonary or respiratory condition which could support a grant of service connection. As such, the Board finds that the primary criterion of service connection has not been met and the claim must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102.

M. Pryce

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Loy, T.

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.

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