SARCOIDOSIS

Summary

The Veteran, a Veteran who served from February 1975 to January 1976, appeals the denial of service connection for sarcoidosis. The Veteran contends his sarcoidosis is due to military service, specifically citing Toxic Exposure Risk Activities (TERA) related to his aviation fuel pumping duties aboard the U.S.S. Constellation. The Regional Office favorably found the Veteran has sarcoidosis and conceded his participation in TERA. However, the Board reviewed the case based on evidence available as of the February 2025 rating decision, noting a favorable October 2024 private nexus opinion could not be considered. A May 2024 VA examination concluded that sarcoidosis is less likely than not caused by jet fuel exposure, citing unknown etiological agents and the importance of biopsy for diagnosis, which the Veteran declined. The examiner noted the diagnosis was based on a chest CT scan showing findings consistent with pulmonary sarcoidosis. The Board found the VA opinion persuasive due to its rationale and scientific support. The Board also noted that sarcoidosis was diagnosed in 2010, over three decades after service, and did not manifest within one year of separation. While the Veteran mentioned sarcoidosis under the PACT Act, he did not serve in qualifying locations for presumptive service connection. The Board found the evidence did not establish a nexus to service or a timely manifestation, and the benefit of the doubt doctrine did not apply as the evidence was not in equipoise. Service connection for sarcoidosis was denied.

Rationale

VA examination found sarcoidosis less likely than not caused by TERA.; Diagnosis occurred over three decades after service.; Veteran did not serve in PACT Act qualifying locations for presumptive sarcoidosis.

Full Decision Text

Citation Nr: A26037636
Decision Date: 04/22/26	Archive Date: 04/22/26

DOCKET NO. 250207-542156
DATE: April 22, 2026

ORDER

Service connection for sarcoidosis is denied.

FINDING OF FACT

The Veteran's sarcoidosis is not shown to be causally or etiologically related to his military service, to include as a result of toxic exposure risk activities (TERA), and did not manifest within one year of separation from military service.

CONCLUSION OF LAW

The criteria for service connection for sarcoidosis have not been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from February 1975 to January 1976.  This matter comes to the Board of Veterans' Appeals (Board) on appeal from a June 2024 rating decision issued by a Department of Veterans Affairs (VA) Regional Office under the modernized appeals system known as the Appeals Modernization Act (AMA).

In February 2025, the Veteran submitted a VA Form 10182, Decision Review Request: Board Appeal, and requested the AMA direct docket.  Under the rules of the AMA, the Board's review is limited to the evidence associated with the claims file as of the date of the June 2024 rating decision on appeal.  38 C.F.R. § 20.301.  In this regard, the Veteran submitted a favorable nexus opinion in October 2024, which the Board cannot review at this time.

If the Veteran would like VA to consider this or any other evidence that was submitted that the Board cannot consider herein, he 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 with this decision.  

Entitlement to service connection for sarcoidosis. 

The Veteran contends he has sarcoidosis due to his military service.

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303.  Generally, service connection requires three elements: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury.  Shedden v. Principi, 381 F.3d. 1163, 1166-67 (Fed. Cir. 2004).  Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Notably, certain chronic disease, such as sarcoidosis, will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree with a presumptive period following separation from service (typically one year); or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease.  38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d. 1331, 1338 (Fed. Cir. 2013).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990).  

The June 2024 rating decision made the favorable finding that the Veteran has been diagnosed with a disability as VA treatment records show a diagnosis of sarcoidosis.  The Board is bound by this favorable finding absent clear and unmistakable evidence to the contrary, which is not present in the instant case.  

The June 2024 rating decision also favorably conceded the Veteran's participation in a TERA based on his service aboard the
 is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990).  

The June 2024 rating decision made the favorable finding that the Veteran has been diagnosed with a disability as VA treatment records show a diagnosis of sarcoidosis.  The Board is bound by this favorable finding absent clear and unmistakable evidence to the contrary, which is not present in the instant case.  

The June 2024 rating decision also favorably conceded the Veteran's participation in a TERA based on his service aboard the U.S.S. Constellation and his aviation fuel pumping duties.  

The remaining question before the Board is whether there is a nexus between the Veteran's current sarcoidosis and his military service, to include the conceded TERA.

In May 2024, the Veteran was afforded a VA medical examination to determine the nature and etiology of his sarcoidosis.  The examiner opined that the Veteran's sarcoidosis is less likely than not caused by the indicated toxic exposure risk activities, 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.  The examiner noted that the Veteran had declined a biopsy to solidify whether certain granulomas were associated and clinically correlative to sarcoidosis.  As a result, the examiner explained that it was difficult to note if there was a clinically proven diagnosis.  In most patients, a definitive diagnosis of sarcoidosis requires biopsy (such as of the skin, lymph node, or lung) to determine whether granulomas, tiny collections of immune cells, are present.  The Kveim-Siltzbach skin test can also be used to diagnosis sarcoidosis.  The examiner explained that the Veteran was diagnosed with sarcoidosis based on findings on a chest CT scan, which showed the following impression: upper lobe predominant peribronchovascular nodularity in keeping with pulmonary sarcoidosis, and small calcified mediastinal and hilar lymph nodes in keeping with granulomatous disease.  

Regardless, the examiner opined that there is little to no clinical indication that exposure to jet fuel causes sarcoidosis.  The examiner refers to an article from Mount Sinai and explains that despite extensive research over the past several decades, the etiological agents of sarcoidosis remain unknown.  Numerous potential etiological agents have been identified, and the most recent hypothesis suggests that host-microbe interaction and genetic factors play an important role in the pathogenesis of this disease when they interact with various environmental factors, which results in the clinical presentation of this disease.  As such, it is less likely than not that the Veteran's exposure to jet fuel would have involvement in the diagnosis of his sarcoidosis.

As the examiner reviewed the Veteran's service treatment records, post-military treatment records, took into consideration the Veteran's lay statements, and substantiated the opinion with rationale supported by scientific evidence, the Board affords this opinion significant probative weight.

Here, the Veteran does not assert, nor does the evidence show, that sarcoidosis had its onset during service or manifested within one year of his separation from service. The Veteran's post-military medical treatment records begin documentation in 2010, which is more than three decades after service.  It also appears that the chest CT scan, which led to the diagnosis of sarcoidosis, was not performed until 2010.  The passage of time between discharge from active service and the medical documentation of a claimed disability is a factor that tends to weigh against a service connection claim. 

The Board notes an October 2023 statement in support of claim, wherein the Veteran contends that sarcoidosis is a list of diseases associated with the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022, Pub. L. No. 117-168, 136 Stat. 1759 (2022) (commonly known as the "Honoring Our PACT Act of 2022" or "PACT Act"). In this regard, sarcoidosis is a disease listed under 38 U.S.C. § 1120 for which service connection may be presumed due to exposure to burn pits and other toxins.  However, the Board notes the Veteran did not serve in any of the locations identified under the PACT Act for this presumption to apply, and he is not a Persian Gulf veteran.  As such, the Veteran does not meet the qualifications for presumptive service connection for sarcoidosis under the PACT Act.    

The Veteran is competent to report his symptoms and his medical history.  To the extent that the Veteran asserts, without supporting evidence, a relationship between
 "Honoring Our PACT Act of 2022" or "PACT Act"). In this regard, sarcoidosis is a disease listed under 38 U.S.C. § 1120 for which service connection may be presumed due to exposure to burn pits and other toxins.  However, the Board notes the Veteran did not serve in any of the locations identified under the PACT Act for this presumption to apply, and he is not a Persian Gulf veteran.  As such, the Veteran does not meet the qualifications for presumptive service connection for sarcoidosis under the PACT Act.    

The Veteran is competent to report his symptoms and his medical history.  To the extent that the Veteran asserts, without supporting evidence, a relationship between his sarcoidosis and service, this is precisely the type of complex medical issue relating to an internal medical process which extends beyond an immediately observable cause-and-effect relationship as to which lay evidence is not competent. Jandreau v. Nicholson, 492 F.3d 1372 at 1376, n. 4 (Fed. Cir. 2007) ("sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer").  In contrast, the May 2024 VA opinion is competent nexus evidence and persuasive in this regard.

For the foregoing reasons, the probative, competent evidence does not show that the Veteran's sarcoidosis is causally or etiologically related to service, to include his acknowledged participation in a TERA, and sarcoidosis did not manifest to a compensable degree within a year of his separation from active duty.  As the evidence is not in relative equipoise, the benefit of the doubt rule does not apply, and the appeal must be denied.  38 U.S.C. § 5107; 38 C.F.R. § 3.102. 

 

M. M. Celli

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	R. 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.