SARCOIDOSIS

Summary

The Veteran, an honorable Navy veteran who served from May 1983 to May 1987, appeals the denial of service connection for sarcoidosis. The Veteran claimed the condition was related to service, including toxic exposure risk activities (TERA). The Board found that the Veteran had a diagnosed disability (sarcoidosis) and that service records indicated a probability of asbestos exposure during service, with TERA participation conceded. The primary issue was the nexus between the sarcoidosis and service. A July 2023 VA examination opined that the condition was less likely than not caused by TERA, but the opinion lacked adequate explanation. The RO denied service connection based on this opinion. However, a private medical nexus opinion received in June 2024 provided a positive opinion, stating it was at least as likely as not that sarcoidosis started in service and that the Veteran deserved the benefit of the doubt. This private opinion was detailed and did not rule out a relationship between TERA and sarcoidosis. The Board found the private opinion competent and probative, tending to favor service connection. Given the approximate balance of evidence and resolving reasonable doubt in the Veteran's favor, the Board granted service connection for sarcoidosis on a direct basis.

Rationale

Favorable findings by RO: diagnosed disability, August 2024 VA exam shows sarcoidosis, service records show probability of asbestos exposure, TERA participation conceded.; Conflicting medical opinions: July 2023 VA opinion was less likely than not caused by TERA but lacked explanation; June 2024 private opinion provided positive nexus.; Board found private opinion competent and probative, tending to favor service connection.

Full Decision Text

Citation Nr: A26030916
Decision Date: 04/06/26	Archive Date: 04/06/26

DOCKET NO. 250923-590948
1DATE: April 6, 2026

ORDER

Service connection for sarcoidosis on a direct basis is granted.

FINDING OF FACT

The evidence is at least approximately balanced as to whether the Veteran's sarcoidosis is as likely as not, otherwise directly related to his active-duty service to include in-service toxic exposure risk activities (TERA).

CONCLUSION OF LAW

The criteria for establishing entitlement to service connection for sarcoidosis have been met. 38 U.S.C. §§ 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303.  

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had honorable active-duty service with the United States Navy from May 1983 to May 1987.

The matter comes before the Board of Veterans' Appeals (Board) from September 2024 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO), which as relevant here, denied the Veteran entitlement to service connection for sarcoidosis.

The rating decision on appeal was issued in September 2024 and constitutes an initial decision. Therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In June 2024, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of the issue on appeal, then most recently addressed in a February 2023 rating decision. In September 2024, the RO issued the rating decision on appeal, which found that "[a]lthough new and relevant evidence has been identified showing a continuous diagnosis of sarcoidosis, service connection for sarcoidosis remains denied." Under the AMA, the Board is bound by favorable findings by the RO in the absence of evidence of clear and unmistakable error. See 38 C.F.R. § 3.104(c). Accordingly, the Board finds that the RO did find that new and relevant evidence had been received and adjudicated the claim based on the merits.

In September 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.

Therefore, the Board may only consider the evidence of record at the time of September 2024 rating claim decision on appeal, as well as any evidence submitted by the Veteran or an authorized representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the RO issued the rating decision on appeal and prior to receipt of the VA Form 10182, or (2) more than 90 days following receipt of the VA Form 10182, the Board may not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included following this decision.

Service connection for sarcoidosis

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Service connection may also be granted for any disability diagnosed after discharge from service when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d).

In general, service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship ("nexus") between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Lay evidence can be competent and sufficient to establish a diagnosis or etiology when: (1) a lay person is competent to identify a medical condition; (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis
 general, service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship ("nexus") between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Lay evidence can be competent and sufficient to establish a diagnosis or etiology when: (1) a lay person is competent to identify a medical condition; (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).

A layperson, such as the Veteran, is competent to report on matters observed or within his personal knowledge, to include the occurrence of injury, and as to the nature, onset, and continuity of symptoms experienced or observed. See 38 C.F.R. § 3.159(a)(2); Charles v. Principi, 16 Vet. App. 370 (2002); Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Board, however, retains the discretion to determine the credibility and probative value of all evidence of record, including lay evidence. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006).

VA is responsible for determining whether the evidence persuasively favors one side or another. 38 C.F.R. § 4.3. When there is an approximate or nearly equal balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the Veteran and the claim will be granted on the merits. 38 U.S.C. § 5107(b). When the evidence persuasively favors against the claim of the Veteran, the benefit of the doubt doctrine is inapplicable, and the claim will be denied on its merits. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021) (en banc).

In August 2022, the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act (PACT Act) was signed into law. Therein, under 38 U.S.C. § 1168, if a Veteran submits a claim for compensation for service connection with evidence of a disability and evidence of participation in TERA during active military, naval, air, or space service, and such evidence is not sufficient to establish a service connection for the disability, VA shall provide the Veteran with a medical examination and obtain a medical opinion as to whether it is at least as likely as not that there is a nexus between the disability and the TERA. The PACT Act established additional presumptive diseases for TERA in-service. 38 C.F.R. § 3.309; 38 U.S.C. § 1116(a)(2). That said, even if a disease is listed as presumed, direct service connection must be considered especially if it results in a full grant of benefits sought. See Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994).

The Veteran has maintained that his diagnosed sarcoidosis is related to his service to include TERA. See September 2025 VA 21-4138 Statement in Support of Claim.

Favorable findings noted in the September 2024 rating decision on appeal include that the Veteran has been diagnosed with a disability; August 2024 VA examination shows a diagnosis of sarcoidosis; evidence shows a qualifying event during service noting service records for the period May 1983 to May 1987 show a probability for asbestos exposure. Participation in a TERA is conceded. Memorandum dated September 24, 2024, shows the Veteran participated in a TERA. Under the AMA, the Board is bound by favorable findings by the RO in the absence of evidence of clear and unmistakable error. See 38 C.F.R. § 3.104(c). The Board also acknowledges that the evidence of record includes a July 2023 TERA Memorandum reporting that, "...there is evidence of non-deployment related exposure (such as Military Occupational Specialty ... exposures; any relevant location, dates and length of each exposure, etc.): The Veteran claims exposure to asbestos, lead based paint, crystalline silica, talc, aluminum silicates, titanium dioxide, aluminum
. Participation in a TERA is conceded. Memorandum dated September 24, 2024, shows the Veteran participated in a TERA. Under the AMA, the Board is bound by favorable findings by the RO in the absence of evidence of clear and unmistakable error. See 38 C.F.R. § 3.104(c). The Board also acknowledges that the evidence of record includes a July 2023 TERA Memorandum reporting that, "...there is evidence of non-deployment related exposure (such as Military Occupational Specialty ... exposures; any relevant location, dates and length of each exposure, etc.): The Veteran claims exposure to asbestos, lead based paint, crystalline silica, talc, aluminum silicates, titanium dioxide, aluminum, other chemicals on ship and has provided medical documentation to substantiate these claims. Please see evidence: - Correspondence, TERA exposures claimed, 2/11/2023 -Correspondence, CDC article - Sarcoidosis among Navy, 2/11/2023." Therefore, the first two elements of service connection are met.

Accordingly at issue is the final criteria necessary for service connection, a nexus between the diagnosed condition and the Veteran's service. In July 2023 VA Medical Opinion, it was reported that the claimed sarcoidosis condition was less likely than not caused by the "... indicated TERA, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran." The conclusory opinion provided the above without offering an adequate explanation of the literature or cited sources of information.

In the September 2024 rating decision on appeal, the RO denied service connection for sarcoidosis stating that " [] the evidence of record shows participation in a TERA, the medical opinion provided by [] VA examiner does not show an association between [the] claimed disability and in-service TERA as [] VA examiner on July 27, 2023 opined that it was less likely than not [the] claimed condition was caused by the indicated toxic exposure risk activities as the indicated activities (including asbestos exposure) were not sufficiently established as being etiological agents in the pathogenesis of [] sarcoidosis. (38 USC 1168, 38 CFR 3.303)." Nevertheless, the July 2023 VA opinion relied upon fails to rule out any relationship between the Veteran's in-service TERA and diagnosed sarcoidosis.

Here, the evidence of record includes a private medical nexus opinion regarding the claimed condition and the Veteran's service to include TERA. In this medical opinion the private physician provided positive nexus opinion for the condition claimed here. Specifically, the provider indicated that "... all of the above at least as likely as not does put the possibility of sarcoid having started in service. Veteran deserves the benefit of the doubt." See C&P Exam received by VA June 26, 2024.

Further, the 2024 private medical nexus opinion received in June 2024 provides detailed explanation for the opinion expressed. Notably, it clearly fails to rule out that in-service TERA may otherwise be related to the claimed condition on appeal. As such, the private medical evidence is consistent with the July 2023 VA medical opinion. Both opinions are based on review of the Veteran's relevant military and/or personal history. As such, the Board finds the private medical opinion received by VA in June 2024 to be competent and probative evidence that tends to favor the Veteran's service connection claim for sarcoidosis on a direct basis.

While the Board arguably could remand the matter for further VA examination and/or etiology opinion, such a request could be construed as an attempt to obtain additional evidence for the sole purpose of denying a claim, which is impermissible. Andrews v. McDonough, 34 Vet. App. 216, 225 (2021) ("Remand is inappropriate where the predominant purpose is not to allow the Board to make a fully informed decision unencumbered by error but to allow VA to obtain more evidence so that it can properly deny the claim."). Moreover, because the Board is granting service connection for the claimed condition, the maximum benefit sought as to the disability, remand is not required. 38 C.F.R. § 20.802(a).

Accordingly, looking at the evidence as a whole, the Board finds the evidence is in at least approximate balance as to whether the Veteran's current diagnosed sarcoidosis is otherwise related to his service. Thus, resolving reasonable doubt in favor of the Veteran, service connection for sarcoidosis, is granted. Lynch, 21 4th 776; 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 

 

Christopher Seppanen

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Kelly, E. C.


 sought as to the disability, remand is not required. 38 C.F.R. § 20.802(a).

Accordingly, looking at the evidence as a whole, the Board finds the evidence is in at least approximate balance as to whether the Veteran's current diagnosed sarcoidosis is otherwise related to his service. Thus, resolving reasonable doubt in favor of the Veteran, service connection for sarcoidosis, is granted. Lynch, 21 4th 776; 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 

 

Christopher Seppanen

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Kelly, E. C.

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.