KNEE IMPAIRMENT OF

J. PARKER · 2026 · Case ID: A26035919

MIXED

Summary

The veteran, who served from September 2012 to December 2014, appeals the denial of service connection for obstructive sleep apnea and the denial of a higher disability rating for sarcoidosis, while seeking service connection for a left knee disability. The Board granted service connection for the left knee disability, finding that the evidence was in relative equipoise regarding in-service onset and continuity of symptoms, and resolving doubt in the veteran's favor. The veteran's own statements and VA treatment records indicated continuous symptoms since service, despite some records suggesting a later onset. For sleep apnea, the Board denied service connection, finding the evidence weighed against an in-service respiratory injury or event related to sleep apnea. The Board noted that sleep problems reported during service were consistently linked to a service-connected psychiatric disability, and that the veteran's sleep apnea was not clinically diagnosed until approximately 10 years after service separation. Regarding sarcoidosis, the Board denied a higher disability rating for the review period from November 5, 2024. While the veteran had chronic cough and shortness of breath on exertion, and nightly sweats, the Board found these symptoms did not meet the criteria for higher ratings under Diagnostic Codes 6846 or 6600, as they did not require corticosteroid treatment or demonstrate significant pulmonary function impairment.

Rationale

Evidence in relative equipoise on in-service onset and continuity; Resolving reasonable doubt in veteran's favor; Contemporaneous statements and treatment records support in-service onset and continuity

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

6846

Docket No.

250821-578557

Full Decision Text

Citation Nr: A26035919
Decision Date: 04/16/26 Archive Date: 04/16/26

DOCKET NO. 250821-578557
DATE: April 16, 2026

ORDER

Service connection for a left knee disability is granted.

Service connection for obstructive sleep apnea (sleep apnea) is denied.

For the review period from November 5, 2024, a higher (compensable) initial disability rating for the service-connected sarcoidosis is denied.

FINDINGS OF FACT

1. The evidence shows a currently diagnosed left knee disability, alternatively characterized as a left knee strain, left knee anterior synovial cyst with possible meniscal pathology, left knee patellofemoral pain syndrome, and left knee internal derangement or meniscal tear causing left knee arthroscopy and debridement (left knee disability).

2. The current left knee disability had its onset during service.

3. Symptoms of a left knee disability (chronic left knee pain) have been continuous since the in-service onset.

4. The evidence shows a current disability of sleep apnea.

5. There was no in-service relevant respiratory injury, disease, or event, or other sleep symptoms etiologically related to obstructive sleep apnea.

6. For the review period from November 5, 2024, the symptomatology and functional impairment of the service-connected sarcoidosis did not more nearly approximate pulmonary involvement with persistent symptoms requiring chronic low dose (maintenance) or intermittent corticosteroids.

7. For the review period from November 5, 2024, the symptomatology and functional impairment of the service-connected sarcoidosis did not more nearly approximate Forced Expiratory Volume in one second (FEV-1) of 71- to 80-percent predicted, the ratio of FEV-1 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)) of 66- to 80-percent predicted.

CONCLUSIONS OF LAW

1. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for a left knee disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for sleep apnea have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. For the review period from November 5, 2024, the criteria for a higher (compensable) initial disability rating for the service-connected sarcoidosis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.97, Diagnostic Codes 6600, 6846.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran, who is the appellant, had active service from September 2012 to December 2014.

The instant case is on appeal to the Board of Veterans' Appeals (Board) from multiple Department of Veterans (VA) Regional Office (RO) rating decisions. The modernized review system, also known as the Appeals Modernization Act (AMA), applies.

Pertaining to the left knee disability, the Veteran submitted a August 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) seeking service connection for a left knee disability and identifying a March 2025 VA RO rating decision as the one on appeal.

Although in March 2025 the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of the March 2025 VA RO rating decision, leading to another denial of service connection for a left knee disability in August 2025, the Veteran is permitted to choose more than one review option for the same issue, provided that each review option election is timely. In this case, the August 2025 VA Form 10182 is within one year of the March 2025 VA RO rating decision, so it is timely with respect to this disability, and it is the rating decision on appeal with respect to the left knee disability, notwithstanding the later August 2025 denial.

In the August 2025 Notice of Disagreement, the Veteran elected the Direct Review docket; therefore, the Board may only consider the evidence of record at the time of the March 2025 VA RO rating decision on appeal with respect to
a left knee disability in August 2025, the Veteran is permitted to choose more than one review option for the same issue, provided that each review option election is timely. In this case, the August 2025 VA Form 10182 is within one year of the March 2025 VA RO rating decision, so it is timely with respect to this disability, and it is the rating decision on appeal with respect to the left knee disability, notwithstanding the later August 2025 denial.

With respect to the obstructive sleep apnea appeal, the Veteran identified the March 2025 VA RO rating decision as the one on review for obstructive sleep apnea, but the March 2025 VA RO rating decision is a deferral of a decision on the issue, rather than a final decision; as such, it cannot be the rating decision on appeal with respect to obstructive sleep apnea. See Shipley v. Shinseki, 24 Vet. App. 458, 461 (2011) (holding a deferred decision does not constitute an "adjudicative determination" from which a notice of disagreement may be filed).

In April 2025, the VA RO issued a rating decision denying service connection for obstructive sleep apnea. As the August 2025 Notice of Disagreement is timely with respect to this rating decision and would pertain to the same benefit that the Veteran seeks (service connection for obstructive sleep apnea), the Board will construe the August 2025 Notice of Disagreement as an appeal with respect to service connection for obstructive sleep apnea related to the April 2025 VA RO rating decision.

In the August 2025 Notice of Disagreement, the Veteran elected the Direct Review docket; therefore, the Board may only consider the evidence of record at the time of the April 2025 VA RO rating decision on appeal with respect to the obstructive sleep apnea. 38 C.F.R. § 20.301. Any evidence submitted after the April 2025 VA RO rating decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

Pertaining to the sarcoidosis, the August 2025 Notice of Disagreement listed the March 2025 VA RO rating decision that denied service connection for sarcoidosis as the one being reviewed. In March 2025, the Veteran submitted an HLR request and requested review of the March 2025 decision. In August 2025, the VA RO granted service connection for sarcoidosis and established a 0 percent (noncompensable) disability rating for sarcoidosis, effective November 5, 2024, which was the original date of claim for the issue. As service connection has been granted for sarcoidosis, and as the August 2025 Notice of Disagreement listed "disability evaluation" as one of the issues, the Board will construe the August 2025 Notice of Disagreement to be challenging the initial (noncompensable) disability rating that was assigned for the sarcoidosis, effective November 5, 2024, rather than relitigating the issue of service connection for sarcoidosis, which would result in no additional benefit.

In the August 2025 Notice of Disagreement, the Veteran elected the Direct Review docket; therefore, the Board may only consider the evidence of record at the time of the August 2025 VA RO rating decision with respect to the initial disability rating for the sarcoidosis. 38 C.F.R. § 20.301. Any evidence submitted after the August 2025VA RO rating decision cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 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 or claims, considering the new evidence in addition to
rating for the sarcoidosis. 38 C.F.R. § 20.301. Any evidence submitted after the August 2025VA RO rating decision cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 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 or claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection Legal Authority

The Veteran appeals for service connection for a left knee disability and for sleep apnea. The specific contentions, to the extent that they were raised, are discussed in the pertinent sections below.

Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 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 competent 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.

1. Service Connection for a Left Knee Disability is Granted.

The Veteran appeals for service connection for a left knee disability, contending that symptoms of a left knee disability, to include (chronic left knee pain, had their onset during service and have continued since service separation. See June 2015 VA Examination.

The evidence shows a current diagnosis of a left knee disability. See, e.g., June 2015 VA Examination (left knee strain); August 2023 VA Treatment Record (left knee anterior synovial cyst with possible meniscal pathology); October 2023 VA Treatment Record (left knee internal derangement, requiring left knee arthroscopy and debridement).

After a review of all the lay and medical evidence of record, the Board finds that the evidence is at least in relative equipoise on the question of whether there was an in-service onset of a left knee disability, with symptoms continuing since service separation, such that service connection can be granted on a direct basis due to an in-service incurrence (38 C.F.R. § 3.303(d)).

In a June 2015 VA examination, the Veteran asserted that the left knee was injured climbing up and down ladders, carrying weights such as nitrogen bottle over many decks and stairs, which resulted in him hitting it. The Veteran said that he had problems with stairs ever since those in-service injuries.

The June 2015 VA examination was conducted based on a claim for service connection for a left knee disability that was submitted in April 2015, which is only four months after service separation. The minimal gap in time provides substantial evidence that the left knee symptoms were present shortly after service separation and supports the Veteran's statement to the June 2015 VA examiner that the left knee symptoms had their onset during service. The Board will resolve reasonable doubt in favor of the Veteran to find that the symptoms of a left knee disability, to include chronic left knee pain, had their onset during service. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

The Board finds that the evidence is at least in relative equipoise on the question of whether the symptoms of the current left knee disability that started during service were continuous since service separation. The Veteran reported to a VA treatment provider in December 2022 that left knee pain had been bothering him since service separation and had increased in severity since then. See also November 2022 VA Treatment Record (reporting that the Veteran did not have an injury or trauma during service but did have left knee pain).

The Board acknowledges that some of the VA treatment records report an onset of left knee pain in 2017, which would be three years after service separation. The Boards finds that these statements merely place the question of whether there were continuous symptoms since service separation into a state of relative equipoise, rather than finding that they negate the other VA treatment records that report a continuity of symptoms since service separation. The Board will resolve reasonable doubt in favor of the Veteran to find that
2022 that left knee pain had been bothering him since service separation and had increased in severity since then. See also November 2022 VA Treatment Record (reporting that the Veteran did not have an injury or trauma during service but did have left knee pain).

The Board acknowledges that some of the VA treatment records report an onset of left knee pain in 2017, which would be three years after service separation. The Boards finds that these statements merely place the question of whether there were continuous symptoms since service separation into a state of relative equipoise, rather than finding that they negate the other VA treatment records that report a continuity of symptoms since service separation. The Board will resolve reasonable doubt in favor of the Veteran to find that the symptoms of the left knee disability, to include chronic left knee pain, have been continuous since service separation. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

Given the above, the Board finds that there is some probative evidence in this case that supports a finding that the current left knee disability had its onset during service and that symptoms continued since service separation. For these reasons, the Board will grant the appeal for direct service connection for a left knee disability.

2. Service Connection for Sleep Apnea is Denied.

The Veteran appeals for service connection for sleep apnea but does not advance any specific contentions as to why service connection for sleep apnea is warranted.

The evidence shows a current diagnosis of severe obstructive sleep apnea that was confirmed by a sleep study. See, e.g., October 2024 VA Treatment Record.

After a review of all the lay and medical evidence of record, the Board finds that the evidence persuasively weighs against a finding that there was an in-service relevant respiratory injury, disease, or event, or an onset of sleep apnea symptoms during service. The claims file does not contain any complaints, symptoms, findings, diagnosis, or treatment for a relevant respiratory injury, disease, or event, or any sleep-related symptoms related to obstructive sleep apnea. Although some sleep-related symptoms were reported, they were linked to a psychiatric disability, for which service connection has already been established and for which compensation is being paid (as the symptom of "chronic sleep impairment"). See 38 C.F.R. § 4.130.

The evidence shows that, during service, the Veteran was treated for an upper respiratory infection, a viral syndrome, left shoulder pain, nausea with vomiting, and psychiatric symptoms, to include an adjustment disorder and anxiety. See Service Treatment Records (STRs). The evidence also shows that separation from service was due to unsuitability as a result of adjustment disorder symptoms, as a medical provider wrote that the Veteran would not benefit from counseling with respect to symptoms and impairments of the adjustment disorder, as the Veteran had "relatively low motivation to change." See November 2014 Service Personnel Record.

These findings by the medical provider explain the findings of the December 2014 Report of Medical History, which is a statement in which a veteran is required to report symptoms or diseases that he or she has currently or has had previously. In this document, the Veteran reported "yes" to foot trouble, an adverse drug reaction, nervous trouble, frequent trouble sleeping, having received counseling, depression or excessive worry, and having been evaluated for a mental condition. This evidence, which is contemporaneous to service, demonstrates that the sleep difficulties that started during service were tied to the psychiatric problems for which the Veteran had been treated unsuccessfully. There were no complaints, symptoms, findings, diagnosis, or treatment for a relevant respiratory injury, disease, or event, or any sleep-related symptoms that were related by a medical provider to obstructive sleep apnea. Additionally, the December 2014 service separation examiner wrote that the Veteran had no significant medical problems that preclude separation and documented that the Veteran took Zoloft (a psychiatric medication).

The contemporaneous statements and medical histories by the Veteran and findings by the medical providers throughout service consistently demonstrate no in-service relevant respiratory injury, disease, or event, as the only treated respiratory disease was an upper respiratory infection, and no sleep-related symptoms that can be attributed to obstructive sleep apnea, as the sleep-related symptoms have been attributed to the psychiatric disability for which the Veteran is being compensated. Sleep symptoms have been explicitly recognized as part of the service-connected psychiatric disorder, which is compensated for with a 50 percent rating. Even a 30 percent rating recognizes "chronic sleep impairment" as a psychological symptom. See 38 C.F.R. § 4.130.

The Board finds that the absence of lay or medical evidence indicated in the complete contemporaneous service treatment records is one factor in support of its finding that the persuasive weight of the lay and medical evidence is against an in
the only treated respiratory disease was an upper respiratory infection, and no sleep-related symptoms that can be attributed to obstructive sleep apnea, as the sleep-related symptoms have been attributed to the psychiatric disability for which the Veteran is being compensated. Sleep symptoms have been explicitly recognized as part of the service-connected psychiatric disorder, which is compensated for with a 50 percent rating. Even a 30 percent rating recognizes "chronic sleep impairment" as a psychological symptom. See 38 C.F.R. § 4.130.

The Board finds that the absence of lay or medical evidence indicated in the complete contemporaneous service treatment records is one factor in support of its finding that the persuasive weight of the lay and medical evidence is against an in-service respiratory injury or disease during service, with the only sleep-related symptoms being attributed to the psychiatric disability. See Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011) (stating that VA may use silence in the service treatment records as evidence contradictory to a veteran's assertions if the service treatment records appear to be complete and the injury, disease, or symptoms involved would ordinarily have been recorded had they occurred) (Lance, J., concurring); Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (citing Fed. R. Evid. 803(7) for the proposition that the absence of an entry in a record may be evidence against the existence of a fact that would ordinarily be recorded).

The Board has not simply relied on the absence of notation in the service treatment records; rather, the Board has relied on the Veteran's own contemporaneous lay report of no symptoms or illnesses during separation from active duty that related to sleep apnea, as opposed to the psychiatric disability, and no symptoms or illnesses at separation from active service, and on the fact that the Veteran was taking a psychiatric medication and is service connected and compensated for the symptom of chronic sleep impairment. See 38 C.F.R. § 4.130.

The evidence shows that, in January 2015, which is approximately one month after service separation, the Veteran filed a claim seeking service connection for depression, anxiety, and "sleep problems," which suggests that the Veteran was grouping the sleep-related problems in with the psychiatric disability and, at a minimum, that the psychiatric disability was the focus of concern.

In April 2015, the VA RO granted service connection for "an adjustment disorder with anxiety and depressed mood with sleep problems," relying on an April 2015 VA examination that diagnosed an adjustment disorder. The April 2015 VA examiner noted the sleep problems that the Veteran had experienced, which included being easily fatigued and tired, non-restorative sleep, snoring, and tossing and turning. The Veteran had not had a sleep study done and the April 2015 VA examiner did not suggest that one was warranted but only noted its absence. The April 2015 VA examiner listed chronic sleep impairment as being one of the symptoms of the psychiatric disability and the VA RO in April 2015 compensated the Veteran, in part, for "sleep problems," including the listed symptom of chronic sleep impairment.

Overall, the evidence shows that the symptoms of sleep-related problems that the Veteran reported as occurring during service were consistently related to the psychiatric disability. Compensating the Veteran for sleep symptoms as related to the later diagnosed obstructive sleep apnea would constitute impermissible pyramiding (compensating a veteran twice for the same symptoms or functional impairment), even if the Board were to find that there were sleep-related problems that can instead be attributed to sleep apnea, which the Board is not finding in this decision. See 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits compensating a veteran twice for the same symptoms or functional impairment).

The Veteran subsequently filed a claim for service connection for obstructive sleep apnea in May 2015. That claim was denied by the VA RO based on the absence of an in-service relevant injury, disease, or event, which finding the Board finds is supported by the evidence for the reasons given above. Additionally, it does not appear that the condition had been clinically diagnosed at that time. The February 2016 VA treatment provider (i.e., after the May 2015 claim) wrote that the Veteran "endorsed symptoms suspicious for obstructive sleep apnea," but the Veteran did not appear to have had a sleep study until October 2024, which is approximately 10 years after service separation.
symptoms or functional impairment).

For the reasons given above, the Boards finds that the evidence persuasively weighs against a finding of a relevant respiratory injury, disease, or event, or symptoms attributable to sleep apnea, rather than the psychiatric disability. Without an in-service injury or disease or continued symptoms suggestive of sleep apnea, the Board must deny service connection for obstructive sleep apnea.

3. From November 5, 2024, a Higher (Compensable) Initial Disability Rating for Sarcoidosis is Denied.

As explained above, although the March 2025 rating decision that the Veteran listed as being on appeal in the August 2025 Notice of Disagreement denied service connection for sarcoidosis, service connection for sarcoidosis was granted in an August 2025 VA RO rating decision. As the August 2025 Notice of Disagreement lists "disability evaluation" as being on appeal, the Board will consider the assigned initial disability rating for sarcoidosis as being the issue on appeal.

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) found in 38 C.F.R. § Part 4. 38 U.S.C. § 1155. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. Where there is a question as to which of two disability ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3.

When a claimant is awarded service connection and assigned an initial disability rating, separate disability ratings may be assigned for separate periods of time in accordance with the facts found. Such separate disability ratings are known as staged ratings. See Fenderson v. West, 12 Vet. App. 119, 126 (1999) (noting that staged ratings can be assigned at the time an initial disability rating is assigned).

Pursuant to the Rating Schedule, a 0 percent (noncompensable) disability rating is assigned when sarcoidosis is manifested by chronic hilar adenopathy or stable lung infiltrates without symptoms or physiologic impairment. 38 C.F.R. § 4.97, Diagnostic Code 6846.

A 30 percent disability rating is assigned for sarcoidosis with pulmonary involvement with persistent symptoms requiring chronic low dose (maintenance) or intermittent corticosteroids. Id.

A 60 percent disability rating is assigned for sarcoidosis with pulmonary involvement with persistent symptoms requiring high dose (therapeutic) corticosteroids for control. Id.

A 100 percent disability rating is assigned when sarcoidosis with cor pulmonale, or; cardiac involvement with congestive heart failure, or; progressive pulmonary disease with fever, night sweats, and weight loss despite treatment. Id.

Sarcoidosis may also be rated as chronic bronchitis under 38 C.F.R. § 4.97, Diagnostic Code 6600.

Under that Code a 10 percent disability rating is assigned when forced expiratory volume in one second (FEV-1) is 71- to 80-percent of that predicted value, or; when the ratio of forced expiratory volume in one second to forced vital capacity (FEV-1/FVC) is 71 to 80 percent of that predicted, or; when diffusion capacity of the lung for carbon monoxide by the single breath method (DLCO (SB)) is 66- to 80-percent predicted. 38 C.F.R. § 4.97, Diagnostic Code 6600.

A 30 percent disability rating is assigned when FEV-1 or FEV-1//FVC is 56- to 70-percent of that predicted, or; when DLCO (SB) is 56- to 65-percent predicted. Id.

A 60 percent is assigned when FEV-1 or FEV-1/FVC is 40- to 55-percent of that predicted, or; when DLCO (SB) is 40- to 55-percent of that predicted, or; when maximum oxygen consumption is 15 to 20 ml/kg/min (with cardiorespiratory limit). Id.

Finally, when sarcoidosis is manifested by extra-pulmonary involvement it is rated under the specific bodily system involved. See 38 C.F.R. § 4.97, Diagnostic Code 6846.

After a review of all the lay and medical evidence of record, the Board finds that, for the review period from November 5, 2024, the criteria for a higher (compensable) initial disability rating for the service-connected sarcoidosis have not been met. The evidence persuasively weighs against a finding that, for this review period, the symptomatology and functional impairment of the service-connected sarcoidosis did not more nearly approximate pulmonary involvement with persistent symptoms requiring chronic low dose (maintenance) or intermittent corticosteroids. Additionally, for this review period, the symptomatology and functional impairment of the service-connected sarcoidosis did not more nearly approximate FEV-1 of 71- to 80-percent predicted, the FEV-1/FVC of 71- to 80-percent, or DLCO (SB) of 66- to 80-percent predicted.

At a July 2025 VA examination, the Veteran was evaluated for the specific symptoms that are listed in the Rating Schedule in Diagnostic Code 6846 and participated in the pulmonary function tests (PFTs) that are required by the Rating Schedule for Diagnostic Code 6600. At the July 2025 VA examination, the VA examiner wrote that the Veteran had complained of chronic cough since deployment, and that an examination showed abnormal scarring and lung adenopathy. In February 2025, the diagnosis of sarcoidosis, a rare lung disease, was established. As of the July 2025 VA examination, the Veteran was on a maintenance dose of albuterol, after finishing a steroid taper. The current symptoms were shortness of breath on exertion and chronic cough.

The July 2025 VA examiner indicated that the service-connected sarcoidosis did not require oral or parenteral corticosteroid medications and did require an inhaled medication-intermittent inhalation bronchodilator therapy. There was no physiologic impairment, peristent symptoms of shortness of breath, wheezing, and cough. There was chronic hilar adenopathy, but no stable lung infiltrates. The Veteran had progressive pulmonary disease of plural scarring but did not have pulmonary involvement or cardiac involvement with congestive heart failure or fever. The Veteran had nightly night sweats, but no weight loss.

These findings of the July 2025 VA examiner pertain to the criteria for Diagnostic Code 6846. The current (noncompensable) disability rating correlates with the symptoms that were listed in the July 2025 VA examination. Namely, the Veteran takes intermittent inhalation bronchodilator therapy, which is associated with a noncompensable disability rating, and does not take intermittent or chronic low dose (maintenance) corticosteroids, which is associated with the next higher 30 percent disability rating. The evidence shows hilar adenopathy, which is associated with a noncompens
or cardiac involvement with congestive heart failure or fever. The Veteran had nightly night sweats, but no weight loss.

These findings of the July 2025 VA examiner pertain to the criteria for Diagnostic Code 6846. The current (noncompensable) disability rating correlates with the symptoms that were listed in the July 2025 VA examination. Namely, the Veteran takes intermittent inhalation bronchodilator therapy, which is associated with a noncompensable disability rating, and does not take intermittent or chronic low dose (maintenance) corticosteroids, which is associated with the next higher 30 percent disability rating. The evidence shows hilar adenopathy, which is associated with a noncompensable disability rating, and does not show pulmonary involvement, which is associated with the next higher 30 percent disability rating.

The Board notes that one of the listed symptoms-daily night sweats-is associated with a 100 percent (total) disability rating. The symptoms and functional impairment of the 100 percent disability rating are much more extensive than simply night sweats, however, requiring cor pulmonale, or; cardiac heart failure, or; progressive pulmonary disease with fever, night sweats, and weight loss despite treatment. Given that the disability rating criteria are significantly more extensive than the Veteran's disability picture and the only correlated symptom is the night sweats, the Board finds that the symptoms and functional impairment of the service-connected sarcoidosis do not more nearly approximate the criteria for a 100 percent disability rating, even after considering the presence of daily night sweats.

Given the above, the Board finds that the evidence persuasively weighs against a finding that the criteria for a compensable disability rating pursuant to Diagnostic Code 6846 have not been met.

Concerning Diagnostic Code 6600, which is the alternative approach mentioned in Diagnostic Code 6846, the PFTs must be examined. The July 2025 VA examiner provided the results that were given in a December 2024 pulmonary function test. At that time, the pre-bronchodilator results were a FVC of 93 percent of predicted and a FEV-1/FVC of 102 percent of predicted. The DLCO (SB) was not performed. The post-bronchodilator results were a FEV-1 of 93 percent of predicted and a FEV-1/FVC of 104 percent of predicted. The July 2025 VA examiner wrote that the FEV-1/FVC most accurately reflects the level of disability. The July 2025 VA examiner also wrote that the Veteran has difficulty with running, bicycling, and climbing stairs due to the service-connected sarcoidosis.

Because of the results of these PFTs, the criteria for a 10 percent disability rating pursuant to Diagnostic Code 6600 have not been met. The evidence does not show that, even after consideration of some reduction in performance due to the inhalational therapy, the FEV-1 was 71- to 80-percent of predicted or the FEV-1/FVC of 71- to 80-percent of predicted, which is required or the next higher 10 percent disability rating.

As the criteria for a compensable disability rating for sarcoidosis have not been met under Diagnostic Code 6846 or 6600, the appeal for a higher (compensable) initial disability rating for the service-connected sarcoidosis must be denied from November 5, 2024.

J. PARKER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board A. Smith, Associate 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.

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