SARCOIDOSIS

MICHAEL J. SKALTSOUNIS · 2026 · Case ID: A26040955

MIXED

Summary

The Veteran, a Navy Veteran who served from September 1991 to April 1993, including service in the Southwest Asia theater of operations during the Persian Gulf War, appeals multiple denials and remands from the VA. The Veteran sought service connection for various conditions, including pulmonary sarcoidosis, migraine headaches, degenerative arthritis in the left knee, right knee disorder, left and right ankle conditions, right shoulder rotator cuff tendonitis, bilateral flat feet, bilateral plantar fasciitis, hammer toe of the left second toe, and right foot metatarsalgia. The Veteran also appealed the denial of service connection for PTSD and unspecified trauma and stressor-related disorder with alcohol use disorder, anxiety, and depression. The Board granted service connection for pulmonary sarcoidosis at 10%, migraine headaches, degenerative arthritis in the left knee, right knee disorder, left and right ankle conditions, right shoulder rotator cuff tendonitis, bilateral flat feet, bilateral plantar fasciitis, hammer toe of the left second toe, and right foot metatarsalgia. The Board remanded claims for PTSD and unspecified trauma and stressor-related disorder with alcohol use disorder, anxiety, and depression. The Board found the evidence persuasive for the granted conditions, noting that it was at least as likely as not that these conditions were related to service. The remanded claims were based on the Veteran's contentions of combat exposure, witnessing death and injury, fear of hostile activity, and the impact of these experiences, which were supported by lay statements from his spouse and VA treatment records indicating PTSD and depression symptoms.

Rationale

Criteria for 10 percent rating met; Evidence shows FEV-1/FVC ratio between 71-80%

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250609-551935

Full Decision Text

Citation Nr: A26040955
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 250609-551935
DATE: April 30, 2026

ORDER

Entitlement to an initial rating of 10 percent, but not higher, for pulmonary sarcoidosis is granted.

Service connection for migraine headaches is granted.

Service connection for degenerative arthritis, left knee is granted.

Service connection for right knee disorder, to include degenerative arthritis (osteoarthritis), also claimed as degenerative arthritis (osteoarthritis) in bilateral knees, is granted.

Service connection for degenerative arthritis (osteoarthritis) in left ankle, claimed as degenerative arthritis (osteoarthritis) in bilateral ankles, is granted.

Service connection for right ankle sprain (claimed and previously addressed as right ankle arthritis) is granted.

Service connection for right shoulder rotator cuff tendonitis is granted.

Service connection for bilateral flat feet (pes planus) is granted.

Service connection for bilateral plantar fasciitis is granted.

Service connection for hammer toe, left second toe, is granted.

Service connection for right foot metatarsalgia is granted.

REMANDED

Service connection for posttraumatic stress disorder (PTSD) is remanded.

Service connection for unspecified trauma and stressor related disorder with alcohol use disorder (also claimed as anxiety and depression) is remanded.

Entitlement to a separate compensable rating for additional disability manifested by generalized joint pain as secondary to service-connected pulmonary sarcoidosis.

FINDINGS OF FACT

1. Throughout the period on appeal, the most probative and persuasive evidence showed that the Veteran's pulmonary function testing resulted in a ratio of Forced Expiratory Volume in one second to Forced Vital Capacity (FEV-1/FVC) of 71 to 80 percent.

2. The most probative and persuasive evidence shows that it is at least as likely as not that the Veteran's migraine headaches are a result of the Veteran's service.

3. The most probative and persuasive evidence shows that it is at least as likely as not that the Veteran's degenerative arthritis, left knee, is a result of the Veteran's service.

4. The most probative and persuasive evidence shows that it is at least as likely as not that the Veteran's right knee disorder, to include degenerative arthritis (osteoarthritis), also claimed as degenerative arthritis (osteoarthritis) in bilateral knees, is a result of the Veteran's service.

5. The most probative and persuasive evidence shows that it is at least as likely as not that the Veteran's degenerative arthritis (osteoarthritis) in left ankle, claimed as degenerative arthritis (osteoarthritis) in bilateral ankles, is a result of the Veteran's service.

6. The most probative and persuasive evidence shows that it is at least as likely as not that the Veteran's right ankle sprain (claimed and previously addressed as right ankle arthritis), is a result of the Veteran's service.

7. The most probative and persuasive evidence shows that it is at least as likely as not that the Veteran's right shoulder rotator cuff tendonitis is a result of the Veteran's service.

8. The most probative and persuasive evidence shows that it is at least as likely as not that the Veteran's bilateral flat feet (pes planus) are a result of the Veteran's service.

9. The most probative and persuasive evidence shows that it is at least as likely as not that the Veteran's bilateral plantar fasciitis is a result of the Veteran's service.

10. The most probative and persuasive evidence shows that it is at least as likely as not that the Veteran's hammer toe, left second toe, is a result of the Veteran's service.

11. The most probative and persuasive evidence shows that it is at least as likely as not that the Veteran's right foot metatarsalgia is a result of the Veteran's service.

CONCLUSIONS OF LAW

1. The criteria for an initial rating of 10 percent, but not higher, for pulmonary sarcoidosis have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.14, 4.21, 4.27, 4.96, 4.97, Diagnostic Code 6846-6600.

2. The criteria for entitlement to service connection for migraine headaches have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.3.

3. The criteria for entitlement to service connection for degenerative arthritis, left knee, have been met. 38 U.S
have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.14, 4.21, 4.27, 4.96, 4.97, Diagnostic Code 6846-6600.

2. The criteria for entitlement to service connection for migraine headaches have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.3.

3. The criteria for entitlement to service connection for degenerative arthritis, left knee, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.3.

4. The criteria for entitlement to service connection for right knee condition and degenerative arthritis (osteoarthritis), also claimed as degenerative arthritis (osteoarthritis) in bilateral knees, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.3.

5. The criteria for entitlement to service connection for degenerative arthritis (osteoarthritis) in left ankle, claimed as degenerative arthritis (osteoarthritis) in bilateral ankles, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.3.

6. The criteria for entitlement to service connection for right ankle sprain (claimed and previously addressed as right ankle arthritis) have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.3.

7. The criteria for entitlement to service connection for right shoulder rotator cuff tendonitis have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.3.

8. The criteria for entitlement to service connection for bilateral flat feet (pes planus) have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.3.

9. The criteria for entitlement to service connection for bilateral plantar fasciitis have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.3.

10. The criteria for entitlement to service connection for hammer toe, left second toe, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.3.

11. The criteria for entitlement to service connection for right foot metatarsalgia have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.3.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served in the United States Navy from September 1991 to April 1993. Also, the Board notes that the Veteran served in the Southwest Asia theater of operations; therefore, he is a Persian Gulf Veteran. See January 2023 VA Memo. Further, the Veteran has verified presumptive toxic exposure risk activity (TERA). See December 2022, April 2024 and September 2025 VA Memos. Finally, the Veteran had an MOS of Aerospace Medical Technician. See DD Form 214.

This matter is before the Board of Veterans' Appeals (Board) on appeal from a June 18, 2024, rating decision, a July 15, 2024, rating decision, and a March 8, 2025, higher-level review rating decision, issued under the Appeals Modernization Act (AMA) by a Department of Veterans Affairs (VA) Regional Office (RO) of the Veterans Benefits Administration (VBA), which is the Agency of Original Jurisdiction (AOJ).

The June 18, 2024, rating decision denied service connection for degenerative arthritis (osteoarthritis)
5 VA Memos. Finally, the Veteran had an MOS of Aerospace Medical Technician. See DD Form 214.

The June 18, 2024, rating decision denied service connection for degenerative arthritis (osteoarthritis) in left ankle, claimed as degenerative arthritis (osteoarthritis) in bilateral ankles, and service connection for right knee disorder, to include degenerative arthritis (osteoarthritis), also claimed as degenerative arthritis (osteoarthritis) in bilateral knees.

The July 15, 2024, rating decision denied service connection for unspecified trauma and stressor related disorder with alcohol use disorder (also claimed as anxiety and depression).

The March 8, 2025, higher-level review rating decision continued denial of entitlement to an initial compensable rating for sarcoidosis with general body and joint pain, continued denial of service connection for PTSD, continued denial of service connection for degenerative arthritis, left knee, continued denial of service connection for right ankle sprain (claimed and previously addressed as right ankle arthritis), continued denial of service connection for degenerative arthritis, left foot, continued denial of service connection for degenerative arthritis, right foot, continued denial of service connection for right shoulder rotator cuff tendonitis and continued denial of service connection for migraine headaches.

On June 9, 2025, the Veteran submitted a timely VA Form 10182 (Decision Review Request: Board Appeal (Notice of Disagreement) reflecting his decision to appeal the AOJ's determinations to the Board via the direct review docket. Accordingly, the Board is limited to review of the evidence in the record through and until the date of the June 18, 2024 (denial of service connection for left ankle and right knee disabilities), and the date of the July 15, 2024 (denial of service connection for unspecified trauma and stressor related disorder with alcohol user disorder) rating decisions. 38 U.S.C. §§ 5104C, 7105, 7113; 38 C.F.R. §§ 20.202(b), 20.301, 3.2500. As to the March 8, 2025, higher-level review rating decision, the Board is limited to review of the evidence of record at the time of the prior AOJ decision for which the appellant requested higher-level review, particularly, the June 18, 2024, rating decision (denial of service connection for left knee disability, denial of service connection for right ankle disability, denial of service connection for left foot and right foot disabilities and denial of service connection for migraine headaches), the July 15, 2024, rating decision (entitlement to initial noncompensable rating for sarcoidosis and denial of service connection for PTSD), and an August 9, 2024, rating decision (denial of service connection for right shoulder disability), as that is the evidence that the AOJ was permitted to consider in the March 8, 2025, higher-level review rating decision on appeal. 38 U.S.C. §§ 5104C, 7105; 38 C.F.R. §§ 20.202, 20.301, 3.2500, 3.2501, 3.2601.

Preliminary note

The Board notes that, as shown by the June 9, 2025, VA Form 10182, the Veteran's appeal includes entitlement to an initial compensable rating for sarcoidosis. Consequently, the Board has included that issue as part of the present appeal, as shown in the title page.

Also, since the record shows that the Veteran's sarcoidosis has been associated with residuals, to include general body and joint pain, the Board has added the issue of entitlement to a separate compensable rating for additional disability manifested by generalized joint pain as secondary to service-connected pulmonary sarcoidosis.

Further, the Board has expanded the issues on appeal pertaining to left and right foot disorders, to include service connection for bilateral flat fee (pes planus), service connection for bilateral plantar fasciitis, service connection for hammer toe, left second toe, and service connection for right foot metatarsalgia, because these are the Veteran's foot disabilities shown by the record. See Clemons v. Shinseki, 23 Vet. App. 1 (
the record shows that the Veteran's sarcoidosis has been associated with residuals, to include general body and joint pain, the Board has added the issue of entitlement to a separate compensable rating for additional disability manifested by generalized joint pain as secondary to service-connected pulmonary sarcoidosis.

Increased ratings

A disability rating is determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule). 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or the illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1.

VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589, 592-593 (1991).

Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3.

The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14. The critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994).

The Veteran's entire history is reviewed when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991).

Where the question for consideration is the propriety of the initial evaluation assigned, evaluation of the evidence since the grant of service connection is required. See Fenderson v. West, 12 Vet. App. 119, 126 (1999).

As pertains to noninitial increased rating claims, pursuant to the "look back" provisions of 38 C.F.R. § 3.400(o)(2), if it is factually ascertainable that an increase in disability occurred within the one-year period prior to the date of claim, the effective date can be the date the increase was shown. Gaston v. Shinseki, 605 F.3d 979, 980-981 (Fed. Cir. 2010).

The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings." Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505, 509 (2007).

In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable rating are not met. 38 C.F.R. §4.31.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by 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 from service when all of the evidence, including lay evidence, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. §
instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable rating are not met. 38 C.F.R. §4.31.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303.

In order to establish service connection for a claimed disability, the following three elements must be satisfied: (1) the existence of a current 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. Hickson v. West, 12 Vet. App. 246 (1999).

Only chronic diseases listed under 38 C.F.R. § 3.309(a) are entitled to the presumptive service connection provisions of 38 C.F.R. § 3.303(b). 38 U.S.C. § 1101(3); Walker v. Shinseki, 708 F.3d 1331, 1335-36 (Fed. Cir. 2013). When a disease at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. 38 C.F.R. § 3.303(b).

However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. Walker v. Shinseki, 708 F.3d 1331, 1336 (Fed. Cir. 2013). Of note, arthritis and migraine headaches are considered chronic diseases under 38 C.F.R. § 3.309(a).

In evaluating the evidence in an appeal, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold the same and, in doing so, accept certain medical opinions over others. Schoolman v. West, 12 Vet. App. 307 (1999). In this regard, the Board has been charged with the duty to assess the credibility and weight given to the evidence. Jandreau v. Nicholson, 492 F.3d 1372 (2007).

Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the claims file. See Prejean v. West, 13 Vet. App. 444, 448-449 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, and a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). In concluding that no relationship between a current disability and military service exists, the examiner may not rely solely on an absence of medical records and not consider any available competent and credible lay statements. Dalton v. Nicholson, 21 Vet. App. 23 (2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336-1336 (2006).

Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

In adjudicating a claim of service connection, the Board is required to evaluate evidence based on places, types, and circumstances of service, as shown by the veteran's military records and all pertinent medical and lay evidence.
have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

When there is an approximate 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 claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in approximate balance, with the veteran prevailing in either event. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

1. Entitlement to an initial rating of 10 percent, but not higher, for pulmonary sarcoidosis is granted.

The Veteran claims entitlement to an initial compensable rating for service-connected pulmonary sarcoidosis.

The Veteran was granted service connection for pulmonary sarcoidosis under the PACT Act with an initial noncompensable (0 percent) rating under 38 C.F.R. § 4.97, Diagnostic Codes 6846, 6600, from November 9, 2022; that is, from a year prior to the Veteran's November 9, 2023, intent to file his January 8, 2024, service connection claim. 38 C.F.R. § 3.114(a)(3).

Hyphenated diagnostic codes are used when a rating under one code requires the use of an additional diagnostic code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27. Diagnostic Code 6846 pertains to Sarcoidosis under Restrictive Lung Disease, and Diagnostic Code 6600 pertains to Bronchitis, chronic under the Diseases of the Trachea and Bronchi of the Respiratory System. 38 C.F.R. § 4.97, Diagnostic Codes 6846, 6600.

Respiratory disorders are rated under Diagnostic Codes 6600 through 6817 and 6822 through 6847. Ratings under those diagnostic codes will not be combined with each other. Rather, a single rating will be assigned under the diagnostic code which reflects the predominant disability with elevation to the next higher rating only where the severity of the overall disability warrants such elevation. 38 C.F.R. § 4.96(a).

Effective October 6, 2006, VA added provisions that clarify the use of pulmonary function tests (PFTs) in evaluating respiratory conditions. See 71 Fed. Reg. 52459 (Sept. 6, 2006) (codified at 38 C.F.R. § 4.96(d)). That is, 38 C.F.R. § 4.96(d) was added to the Rating Schedule, applicable to all applications for benefits received by VA on or after October 6, 2006. In the present case, the Veteran's service connection claim was granted from November 9, 2022, subsequent to the effective date of the change. Therefore, these amendments are applicable to his increased rating claim on appeal.

Diagnostic Code 6846 (sarcoidosis) provides that sarcoidosis with chronic hilar adenopathy or stable lung infiltrates without symptoms or physiologic impairment is rated as noncompensable (0 percent) disabling. Sarcoidosis with pulmonary involvement with persistent symptoms requiring chronic low dose (maintenance) or intermittent corticosteroids is rated as 30 percent disabling. Sarcoidosis with pulmonary involvement requiring systemic high dose (therapeutic) corticosteroids for control is rated as 60 percent disabling. Sarcoidosis with cor pulmonale, or; cardiac involvement with congestive heart failure, or; progressive pulmonary disease with fever, night sweats
are applicable to his increased rating claim on appeal.

Diagnostic Code 6846 (sarcoidosis) provides that sarcoidosis with chronic hilar adenopathy or stable lung infiltrates without symptoms or physiologic impairment is rated as noncompensable (0 percent) disabling. Sarcoidosis with pulmonary involvement with persistent symptoms requiring chronic low dose (maintenance) or intermittent corticosteroids is rated as 30 percent disabling. Sarcoidosis with pulmonary involvement requiring systemic high dose (therapeutic) corticosteroids for control is rated as 60 percent disabling. Sarcoidosis with cor pulmonale, or; cardiac involvement with congestive heart failure, or; progressive pulmonary disease with fever, night sweats, and weight loss despite treatment, is rated as 100 percent disabling. 38 C.F.R. § 4.97, Diagnostic Code 6846.

Additionally, Diagnostic Code 6846 provides that the active disease or residuals of sarcoidosis may alternatively be rated as chronic bronchitis (Diagnostic Code 6600) and extra-pulmonary involvement due to sarcoidosis is rated under the specific body system involved. Id.

Diagnostic Code 6600 (bronchitis) provides that Forced Expiratory Volume in one second (FEV-1) of 71-to 80-percent predicted value, or; the ratio of Forced Expiratory Volume in one second 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)) is 66- to 80-percent predicted, is rated as 10 percent disabling.

FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; DLCO (SB) 56- to 65-percent predicted, is rated 30 percent disabling.

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

Finally, FEV-1 less than 40 percent of predicted value, or; FEV-1/FVC less than 40 percent, or; DLCO (SB) less than 40-percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation), or; cor pulmonale (right heart failure), or; right ventricular hypertrophy, or; pulmonary hypertension (shown by Echo or cardiac catheterization), or; episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy, is rated 100 percent disabling. Id.

The Board emphasizes that under the provisions of 38 C.F.R. § 4.96(a), ratings under Diagnostic Codes 6600 (chronic bronchitis) and 6846 (sarcoidosis) will not be combined with each other. This is because they are coexisting respiratory disorders with overlapping symptomatology. Rather, a single rating will be assigned under the diagnostic code which reflects the predominant disability with elevation to the next higher rating only where the severity of the overall disability warrants such elevation. Id.

On this issue, with regard to Diagnostic Codes 6600 and 6846, assigning separate ratings under these diagnostic codes would constitute pyramiding, contrary to the provisions of 38 C.F.R. § 4.14. However, in rating the Veteran's service-connected pulmonary sarcoidosis, application of 38 C.F.R. § 4.14 does not prohibit the Board from comparing the rating criteria for both Diagnostic Codes 6600 and 6846 and considering which provides a higher evaluation based on the manifestations of the disability. See Butts v. Brown, 5 Vet. App. 532, 537 (1993) (choice of diagnostic code should be upheld if it is supported by explanation and evidence). Therefore, the Board will evaluate the Veteran's pulmonary sarcoidosis under the diagnostic code that will provide the most favorable rating, ever mindful not to pyramid and overly compensate him for the same symptom. See, e.g., Esteban v. Brown, 6 Vet. App. 259, 261 (1994).

The amended regulation 38 C.F.R. § 4.96(d), entitled "Special provisions for the application of evaluation criteria for diagnostic codes 6600, 6603, 6604, 6825-6833, and 6840-6845," has seven subsections. 38 C.F.R. §4
should be upheld if it is supported by explanation and evidence). Therefore, the Board will evaluate the Veteran's pulmonary sarcoidosis under the diagnostic code that will provide the most favorable rating, ever mindful not to pyramid and overly compensate him for the same symptom. See, e.g., Esteban v. Brown, 6 Vet. App. 259, 261 (1994).

The amended regulation 38 C.F.R. § 4.96(d), entitled "Special provisions for the application of evaluation criteria for diagnostic codes 6600, 6603, 6604, 6825-6833, and 6840-6845," has seven subsections. 38 C.F.R. §4.96(d)(1)-(7). The provisions of 38 C.F.R. § 4.96(d)(1)-(7) specifically apply here for Diagnostic Code 6600 for the Veteran's service-connected pulmonary sarcoidosis.

As set forth under 38 C.F.R. § 4.96(d)(1)-(7):

(1) PFTs are required except: (i) when the results of a maximum exercise capacity test are of record and are 20 ml/kg/min or less; if a maximum exercise capacity test is not of record, evaluation is based on alternative criteria; (ii) when pulmonary hypertension (documented by an echocardiogram or cardiac catheterization), cor pulmonale, or right ventricular hypertrophy has been diagnosed; (iii) when there have been one or more episodes of acute respiratory failure; or (iv) when outpatient therapy oxygen is required. 38 C.F.R. § 4.96(d)(1).

(2) If the DLCO (SB) test is not of record, evaluation is based on alternative criteria as long as the examiner states why the test would not be useful or valid in a particular case. 38 C.F.R. § 4.96(d)(2).

(3) When the PFTs are not consistent with clinical findings, evaluation is based on the PFTs unless the examiner states why they are not a valid indication of respiratory functional impairment in a given case. 38 C.F.R. § 4.96(d)(3).

(4) Post-bronchodilator studies are required when PFTs are done for disability evaluation purposes except when the results of pre-bronchodilator PFTs are normal or when the examiner determines that post-bronchodilator tests should not be done and states why. 38 C.F.R. § 4.96(d)(4).

(5) When evaluating based on PFTs, post-bronchodilator results are used in applying evaluation criteria in the Rating Schedule unless the post-bronchodilator results were poorer than the pre-bronchodilator results, in which case the pre-bronchodilator values are used for rating purposes. 38 C.F.R. § 4.96(d)(5).

(6) When there is a disparity between the results of different PFTs (FEV-1 (Forced Expiratory Volume in one second), FVC (Forced Vital Capacity), etc.), so that the level of evaluation would be different depending on which test result is used, the test result that the examiner states most accurately reflects the level of disability is used. 38 C.F.R. § 4.96(d)(6).

(7) If the FEV-1 and the FVC are both greater than 100 percent, a compensable evaluation based on a decreased FEV-1/FVC ratio should not be assigned. 38 C.F.R. § 4.96(d)(7).

Turning to the evidence of record, the Veteran was afforded a VA respiratory conditions examination in May 2024 to determine the severity of his pulmonary sarcoidosis. In the examination, the Veteran reported having current symptoms of fever, malaise, dry cough and dyspnea. The VA examiner noted that the Veteran's disability did not require the use of oral or parenteral corticosteroid medication, inhaled medications, oral bronchodilators, antibiotics, or oxygen therapy. The VA examiner further noted that the Veteran had persistent symptoms of reported malaise and chronic hilar adenopathy, but no other signs or symptoms were noted. As to diagnostic testing, sarcoidosis was confirmed by biopsy of hilar lymph nodes in November 2007. The biopsy showed [t]he lymph node contains numerous noncaseating granulomata effacing normal nodal architecture One focal area at section A1 demonstrates marked calcification. According to outside report, special stains for fungi and AFB were negative however, those slides were not submitted for review No evidence of
not require the use of oral or parenteral corticosteroid medication, inhaled medications, oral bronchodilators, antibiotics, or oxygen therapy. The VA examiner further noted that the Veteran had persistent symptoms of reported malaise and chronic hilar adenopathy, but no other signs or symptoms were noted. As to diagnostic testing, sarcoidosis was confirmed by biopsy of hilar lymph nodes in November 2007. The biopsy showed [t]he lymph node contains numerous noncaseating granulomata effacing normal nodal architecture One focal area at section A1 demonstrates marked calcification. According to outside report, special stains for fungi and AFB were negative however, those slides were not submitted for review No evidence of lymphoma is identified. Findings are compatible with sarcoidosis." Also, x-rays in March 2024 showed "subcentimeter calcified left hilar lymph nodes are seen likely represent sequela of artheromatous disease. Impression: no acute cardiopulmonary abnormalities." Further, x-rays in April 2024 showed "[i]mpression: No radiographic evidence of acute cardiopulmonary abnormalities identified." Pulmonary function tests (PFTs) showed the following pre-bronchodilator results: FVC: 83 percent predicted; FEV-1: 91 percent predicted; and FEV-1/FVC: 79 percent. The VA examiner noted that the test result that most accurately reflected the Veteran's level of disability was FEV-1 % predicted. Also, the VA examiner noted that post-bronchodilator testing had not been completed because pre-bronchodilator results were normal. Further, the VA examiner noted that diffusion capacity of the lung for carbon monoxide by the single breath method (DLCO) testing had not been completed because it was not indicated for the Veteran's particular case. Finally, it was noted that the Veteran did not have multiple respiratory conditions. No other diagnostic test findings and/or results were noted.

After careful consideration, the Board finds that an initial 10 percent rating for the Veeran's pulmonary sarcoidosis is warranted. The evidence shows that the Veteran's pulmonary sarcoidosis manifested with no more than symptoms of fever, malaise, dry cough and dyspnea and chronic hilar adenopathy, which correspond to a noncompensable rating under Diagnostic Code 6846. The next higher ratings of 30 percent and 60 percent require persistent symptoms with use of corticosteroids intermittently or for control. However, in this case, the Veteran's pulmonary sarcoidosis did not require the use of corticosteroids at any time during the appeal period. Additionally, there is no evidence of cor pulmonale, or; cardiac involvement with congestive heart failure, or; progressive pulmonary disease with fever, night sweats, and weight loss despite treatment to warrant a 100 percent rating. The Board notes, however, that in the Veteran's May 2024 VA respiratory conditions examination he had a pre-bronchodilator FEV-1 of 91 percent predicted and a pre-bronchodilator FEV-1/FVC of 79 percent. Pursuant to 38 C.F.R. § 4.96(d)(6), when there is a disparity between the results of different PFTs (FEV-1, FVC, etc.), so that the level of evaluation would be different depending on which test result is used, the test result that the examiner states most accurately reflects the level of disability is used. In this case, the VA examiner found that the Veteran's FEV-1 value most accurately reflected his level of disability. However, giving the Veteran the benefit of the doubt, and taking into consideration that his pre-bronchodilator FEV-1/FVC value manifested as 79 percent, that is, within the 71 to 80 percent range that warrants a 10 percent rating, the Board finds that such initial 10 percent rating is warranted.

The Board further notes that the Veteran's disability did not show FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; DLCO (SB) 56- to 65-percent predicted, to warrant a 30 percent rating under Diagnostic Code 6600. Higher ratings under Diagnostic Code 6600 are not warranted either, in light of the Veteran's pulmonary function testing results. 38 C.F.R. § 4.97, Diagnostic Code 6600.

Accordingly, entitlement to an initial rating of 10 percent, but not higher, for pulmonary sarcoidosis is warranted.

2. Service connection for migraine headaches is granted.

The Veteran claims entitlement to
Veteran's disability did not show FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; DLCO (SB) 56- to 65-percent predicted, to warrant a 30 percent rating under Diagnostic Code 6600. Higher ratings under Diagnostic Code 6600 are not warranted either, in light of the Veteran's pulmonary function testing results. 38 C.F.R. § 4.97, Diagnostic Code 6600.

Accordingly, entitlement to an initial rating of 10 percent, but not higher, for pulmonary sarcoidosis is warranted.

2. Service connection for migraine headaches is granted.

The Veteran claims entitlement to service connection for migraine headaches. Particularly, the Veteran contends that onset of his migraines headaches was due to exposure to toxins and burn pit dust particles while deployed in the Persian Gulf War and by the stresses and anxiety, lack of sleep and long hours common to working in performing duties in a combat zone, and flight deck work, under constant threat of death or enemy attack. See April 2024 VA Form 21-526EZ.

In a May 2024 VA headaches examination, the Veteran was diagnosed with migraine headaches with migraine variants. The VA examiner issued a negative nexus TERA opinion. As support for the opinion, the VA examiner explained that the Veteran's separation examination was unremarkable for headaches. Also, while the Veteran was a corpsman and also had duties on "flight deck on a ship," and there was evidence of toxic exposure during Southwest Asia deployment, exposures to hazards such as combined effect of vaccines, particulate matter, fumes, dust sand and regional endemic condition, was not supported by medical literature as a risk factor for migraine headaches. However, the VA examiner noted that exposure to some environmental hazards such as benzene, which was shown in the Veteran's Individual Longitudinal Exposure Record (ILER), could cause short term headaches in poorly ventilated spaces.

After careful consideration, the Board finds that the May 2024 VA headaches examination of reduced probative value as to the etiology of the Veteran's migraine headaches. Particularly, the examiner relied on the absence of symptoms in service to render his opinion. Also, the examiner did not render a direct service opinion as to the Veteran's claimed disability. Ultimately, however, the VA examiner conceded that headaches could be related to exposure to environmental hazards, such as benzene, which the Veteran presumptively had as shown in his ILER. The Board further notes that as the Veteran's migraines are considered a disease of the nervous system, they can alternatively be service connected based on continuity of symptomatology.

As such, considering the evidence of record in a light most favorable to the Veteran, the Board finds that the evidence is at least in approximate balance regarding whether the Veteran's disability is related to service.

Accordingly, giving the Veteran the benefit of the doubt, service connection for migraine headaches is warranted.

3. Service connection for degenerative arthritis, left knee is granted.

4. Service connection for right knee disorder, to include degenerative arthritis (osteoarthritis), also claimed as degenerative arthritis (osteoarthritis) in bilateral knees, is granted.

The Veteran claims entitlement to service connection for bilateral knee degenerative arthritis. Particularly, the Veteran contends that onset of his bilateral degenerative arthritis (osteoarthritis) was due to heavy lifting and moving of patients, running in heavy gear to casualties, fires, and training events, exposure to heavy seas which caused injury to both knees, falling, etc., constant stressors to legs, knees, feet, ankles with long hours 12-plus of working and standing in difficult positions and performing difficult duties while deployed on Carrier during Persian Gulf War. See January 2024 VA Form 21-526EZ; April 2024 VA Form 21-526EZ.

At the outset, the Board notes that, in a May 2024 VA knee and lower leg conditions examination, the Veteran was diagnosed with bilateral feet degenerative arthritis, other than post-traumatic. The VA examiner noted the Veteran's reporting of onset of his disability in 1995, although he had not sought medical attention and only self-treated with knee braces and pain medication. Also, the VA examiner rendered a TERA negative nexus opinion and explained, as support for his opinion, that the Veteran's disability was a condition caused by wear and tear or trauma. Exposure to hazards such as those unique to service in Southwest Asia and related to the Veteran's MOS, such as fumes, particulate matter, vaccines, had not been found to increase risk for such disability.

After careful consideration, the Board finds the May 2024 VA knee and lower conditions examination of reduced probative value as to the etiology of the Veteran's claimed disability. Particularly
the Veteran's reporting of onset of his disability in 1995, although he had not sought medical attention and only self-treated with knee braces and pain medication. Also, the VA examiner rendered a TERA negative nexus opinion and explained, as support for his opinion, that the Veteran's disability was a condition caused by wear and tear or trauma. Exposure to hazards such as those unique to service in Southwest Asia and related to the Veteran's MOS, such as fumes, particulate matter, vaccines, had not been found to increase risk for such disability.

After careful consideration, the Board finds the May 2024 VA knee and lower conditions examination of reduced probative value as to the etiology of the Veteran's claimed disability. Particularly, the VA examiner relied on the absence of symptoms in service and did not thoroughly address and consider the Veteran's statements related to the onset of his disability while in service. Ultimately, the VA examiner did not render an opinion as to direct service connection for the Veteran's claimed disability. However, he conceded that the Veteran's disability was caused by wear and tear or trauma. Such assessment is consistent with the Veteran's reporting of onset of his disability while he was in service.

Moreover, since the Board finds that the Veteran is competent and credible with respect to the onset and continuing symptoms of his disability, the Board has assigned his statements high probative value. Charles v. Principi, 16 Vet. App. 370, 374 (2002). Lay evidence concerning continuity of symptoms after service, if credible, can ultimately be considered competent, regardless of a lack of contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The Board further notes that arthritis is considered a chronic disease, and therefore service connection may be granted under a theory of chronicity and continuity of symptomatology. 38 C.F.R. §§ 3.303, 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Accordingly, service connection for degenerative arthritis, left knee and right knee disorder, to include degenerative arthritis (osteoarthritis), also claimed as degenerative arthritis (osteoarthritis) in bilateral knees, is also warranted.

5. Service connection for degenerative arthritis (osteoarthritis) in left ankle, claimed as degenerative arthritis (osteoarthritis) in bilateral ankles, is granted.

6. Service connection for right ankle sprain (claimed and previously addressed as right ankle arthritis) is granted.

The Veteran claims entitlement to service connection for bilateral ankle degenerative arthritis (osteoarthritis). Particularly, the Veteran contends that onset of his bilateral degenerative arthritis (osteoarthritis) was due to heavy lifting and moving of patients, running in heavy gear to casualties, fires, and training events, exposure to heavy seas which caused injury to both knees, falling, etc., constant stressors to legs, knees, feet, ankles with long hours 12-plus of working and standing in difficult positions and performing difficult duties while deployed on Carrier during Persian Gulf War. See April 2024 VA Form 21-526EZ.

At the outset, the Board notes that, in a May 2024 VA ankle conditions examination, the Veteran was diagnosed with left ankle degenerative arthritis, other than post-traumatic, and right ankle lateral collateral ligament sprain (chronic/recurrent). The VA examiner noted the Veteran's reporting of onset during service with ongoing symptoms, without receiving any treatment, only self-treatment with pain medication. Also, the VA examiner rendered a TERA negative nexus opinion and explained, as support for his opinion, that the Veteran's disabilities were mainly caused by direct trauma to the joints. While there was objective evidence of toxic exposure during service such as service in Southwest Asia, environmental toxic hazards had not been established as risk factors for sprains, arthritis or tendinitis in medical literature.

After careful consideration, the Board finds the May 2024 VA ankle conditions examination of reduced probative value as to the etiology of the Veteran's claimed disabilities. Particularly, the VA examiner relied on the absence of symptoms in service and did not thoroughly address and consider the Veteran's statements related to the onset of his disabilities while in service. Ultimately, the VA examiner did not render an opinion as to direct service connection for the Veteran's claimed disabilities. However, he conceded that the Veteran's disabilities were mainly caused by trauma to the joints. Such assessment is consistent with the Veteran's reporting of onset of his disabilities while he was in service.

Moreover
established as risk factors for sprains, arthritis or tendinitis in medical literature.

Accordingly, service connection for degenerative arthritis (osteoarthritis) in left ankle, claimed as degenerative arthritis (osteoarthritis) in bilateral ankles, and right ankle sprain (claimed and previously addressed as right ankle arthritis) is also warranted.

7. Service connection for right shoulder rotator cuff tendonitis is granted.

The Veteran claims entitlement to service connection for right shoulder degenerative arthritis (osteoarthritis). Particularly, the Veteran contends that onset of his right shoulder degenerative arthritis (osteoarthritis) was due to nonergonomic lifting and moving of patients while treating them on the "flight deck," in the main medical sickbay, moving heavy stokes stretchers, and long hours of standing either assisting medical doctors and having to place his body in unsafe positions which caused extensive strain to shoulders when lifting patients. See April 2024 VA Form 21-526EZ.

At the outset, the Board notes that, in a May 2024 VA shoulder and arm conditions examination, the Veteran was diagnosed with right shoulder rotator cuff tendonitis. The VA examiner noted the Veteran's reporting of onset continuous right shoulder pain and limited ROM in 2015, never having sought medical attention and only self-treating with pain medication. Also, the VA examiner rendered a negative nexus TERA opinion and explained, as support for his opinion, that the Veteran's disability was due to trauma or repeated use. While there was evidence of toxic exposure, exposure to hazards such as those unique to service in Southwest Asia had not been established as risk factor for rotator cuff tendonitis.

Subsequently, in August 2024, a second VA examiner issued a direct service connection negative nexus opinion. The VA examiner explained, as support for her opinion, that there was a lack of substantiating evidence supporting a nexus between the current diagnosis and military service. Without chronicity during service or after service, a post-service event, illness, or injury was considered to be a more likely etiology; that is, the VA examiner was unable to state that the years after active duty had not caused the claimed right shoulder disability.

After due consideration, the Board finds the May 2024 and August 2024 VA opinions of limited probative values as to the etiology of the Veteran's claimed disability. Particularly, both opinions relied on the absence of symptoms while the Veteran was in service. Also, the opinions did not thoroughly address and consider the Veteran's reporting of onset of his disability while he was in service. Ultimately, the Board notes that the May 2024 VA examiner did concede that the Veteran's disability was due to trauma or repeated use. Such assessment is consistent with the Veteran's reporting of onset of his disability while he was in service.

Accordingly, giving the Veteran the benefit of the doubt, service connection for right shoulder rotator cuff tendon
relied on the absence of symptoms while the Veteran was in service. Also, the opinions did not thoroughly address and consider the Veteran's reporting of onset of his disability while he was in service. Ultimately, the Board notes that the May 2024 VA examiner did concede that the Veteran's disability was due to trauma or repeated use. Such assessment is consistent with the Veteran's reporting of onset of his disability while he was in service.

Accordingly, giving the Veteran the benefit of the doubt, service connection for right shoulder rotator cuff tendonitis is also warranted.

8. Service connection for bilateral flat feet (pes planus) is granted.

9. Service connection for bilateral plantar fasciitis is granted.

10. Service connection for hammer toe, left second toe, is granted.

11. Service connection for right foot metatarsalgia is granted.

The Veteran claims entitlement to bilateral knee arthritis (osteoarthritis). Particularly, the Veteran contends that onset of his disability was due to heavy lifting and moving of patients, running in heavy gear to casualties, fires, and training events, heavy seas which caused injury to both knees, falling, etc., constant stressors to knees with long hours 12-plus of working and standing in difficult positions and performing difficult duties while deployed on carrier during Persian Gulf War. See April 2024 VA Form 21-526EZ.

At the outset, the Board notes that, in a May 2024 VA foot conditions examination, the Veteran was diagnosed with bilateral flat fee (pes planus), bilateral plantar fasciitis, hammer toe, left second toe, and right foot metatarsalgia. The VA examiner noted the Veteran's reporting of onset of symptoms in the 1990s, feet pain shortly after service, having been told he had plantar fasciitis and worsening of bilateral feet pain symptoms. Also, the Veteran reported no current treatment. The VA examiner rendered a negative nexus TERA opinion and explained, as support for his opinion, that the Veteran's diagnosed disabilities had not been implicated to any toxic exposure in medical literature and were likely related to trauma rather than to toxic exposure.

After due consideration, the Board finds the May 2024 VA foot conditions examination of limited probative value as to the etiology of the Veteran's claimed disabilities. Particularly, the VA examiner did not thoroughly address and consider the Veteran's reporting of onset of his disabilities while he was in service. Ultimately, the VA examiner did not render an opinion as to direct service connection for the Veteran's claimed disabilities. However, the Board notes that the VA examiner did concede that the Veteran's disabilities were likely due to trauma. Such assessment is consistent with the Veteran's reporting of onset of his disabilities while he was in service.

Accordingly, giving the Veteran the benefit of the doubt, service connection for bilateral flat fee (pes planus) bilateral plantar fasciitis, hammer toe, left second toe, and right foot metatarsalgia, is also warranted.

REASONS FOR REMAND

1. Service connection for posttraumatic stress disorder (PTSD) is remanded.

2. Service connection for unspecified trauma and stressor related disorder with alcohol use disorder (also claimed as anxiety and depression) is remanded.

The Veteran claims entitlement to PTSD, to include anxiety, nightmares, insomnia and alcohol abuse, and major depression, due to fear of hostile military activity or terrorist activity. Particularly, the Veteran contends that his duty during the Persian Gulf War required him to work on the deck of an aircraft carrier during combat operations, exposing him to great personal harm. Also, the Veteran contends that he was sent to general quarters for inbound enemy aircraft. Further, the Veteran contends that his participation in combat operations in the Persian Gulf led to many deaths of Iraqi military and civilians which in turn has impacted him negatively throughout the Veteran's life. See January 2024 VA Form 21-526EZ; April 2024 VA Form 21-526EZ.

At the outset, in a January 2024 statement, the Veteran's spouse asserted having been married to the Veteran for over 20 years. During that time, she had witnessed the many maladies that the Veteran attributed to his period of military service, including PTSD. The Veteran was deployed to a combat zone where he worked as medic tending injuries to service members while working on the deck of an aircraft carrier. He had told her many stories of the injuries he treated, the death, the dismemberment that he had seen and been exposed to during his deployment during the Persian Gulf War. Also, he related his sorrow and guilt for taking part in the killing of so many people during that time. Further, he related the fear of death or injury he felt daily during that time and how when he heard certain sounds or saw sights that reminded him of his naval service and the war, he became depressed, anxious, and irritated. Finally, he also related how shipmates in his battle group were killed by mines when one of his escort ships was damaged. Since his sleep area was on the waterline, each time he would go to sleep he would wonder if they too would hit a mine. His consumption of alcohol was frequent and excessive when he thought about his past. It was the only thing that made him forget and not care or be angry or depressed.

February 2024 VA treatment records show clinical impression of anxiety, depression, PTSD symptoms, impaired memory, and insomnia concerns. Also, screening tests showed positive for symptoms of PTSD and depression, and suicidal ideation.

In a May 2024 VA initial PTSD examination, the Veteran reported traumatic stressors, including witnessing death or serious injury of others, trauma due to medical technician MOS, being stationed on enemy lines, having mines around him and having a high level of threat daily. The VA examiner diagnosed the Veteran with unspecified trauma and stressor-related disorder and alcohol use disorder. However, the VA examiner stated that the Veteran did not meet the diagnostic criteria for PTSD.

VA has conceded the Veteran's service in Southwest Asia, including an event or circumstance that involved actual or threatened death or serious injury of the Veteran or others, which could reasonably cause the Veteran to react with fear, helplessness, or horror. See July 15, 2024, rating decision on appeal; March 8, 2025, higher-level review rating decision on appeal.

After due consideration, the Board finds the May 2024 VA initial PTSD examination of limited probative value as to the nature and etiology of the Veteran's psychiatric disorders. Particularly, the VA examiner concluded that a PSTS diagnosis could not be rendered without thoroughly addressing and considering the Veteran's reporting of his military experience and symptoms and his spouse's related statements. Also, the VA examiner did not thoroughly address and consider the Veteran's VA treatment records. Further, the VA examiner did not provide a nexus opinion in relation to the rendered diagnoses; that is, unspecified trauma and stressor-related disorder and alcohol use disorder.

Finally, the Board notes that, despite VA's finding pertaining to the Veteran's military history, that is, an event or circumstance that involved actual or threatened death or serious injury of the Veteran or others, no additional VA examination was arranged in order to properly assess the nature and etiology of the Veteran's psychiatric disorder.

Thus, the Board finds that the AOJ's oversight in not developing the Veteran's service connection claims requires a remand of the claims to properly carry out VA's statutory duties under 38 C.F.R. § 20.802(a). See also 38 U.S.C. § 5103A(e)(2); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); Stefl v. Nicholson, 21 Vet. App. 120, 124-125 (2007).

3. Entitlement to a separate compensable rating for additional disability manifested by generalized joint pain as secondary to service-connected pulmonary sarcoidosis.

The Veteran claims that there is additional disability associated with his service-connected sarcoidosis disability. Particularly, the Veteran contends that he has joint pain due to inflammation from sarcoidosis, which affects him daily. See January 2024 VA Form 21-526EZ.

Turning to the evidence of record, in a January 2024 statement, the Veteran's spouse asserted the toll that the Veteran's sarcoidosis had taken on his body. Particularly, the Veteran was in a constant state of discomfort from his joints and suffered general body aches and pains due to the inflammation in his system.

In a May
to a separate compensable rating for additional disability manifested by generalized joint pain as secondary to service-connected pulmonary sarcoidosis.

In a May 2024 VA infectious diseases examination, a VA examiner noted the Veteran's reporting of symptoms, including generalized joint pain.

Further, in a June 2024 VA addendum examination, the same VA examiner opined that it was at least as likely as not that the Veteran's joint pain was proximately due to his service-connected sarcoidosis. As support for the opinion, the VA examiner explained that sarcoidosis was a systemic condition that could present with polyalgia (joints pain). There was no evidence of any muscle injury. However, symptoms depended on the extent and severity of the organ involved.

The Board notes that, while the VA examiner issued a positive nexus opinion as the Veteran's claimed joint pain as residual to his service-connected sarcoidosis, the RO did not address whether such constituted an additional disability associated with the Veteran's pulmonary sarcoidosis that warranted a separate compensable rating, and the failure to address this matter constituted a pre-decisional violation of the duty to assist.

The matters are REMANDED for the following action:

1. The Veteran must be afforded a VA examination by another examiner with appropriate expertise to determine the nature and etiology of the Veteran's claimed psychiatric disorders. Any and all studies, tests, and evaluations that are deemed necessary should be conducted. The claims file, including this remand, should be reviewed by the examiner. After a review of the Veteran's claims file and an examination of the Veteran, the examiner should provide an opinion responding to the following:

(a) The examiner should confirm if the Veteran has a diagnosis of PTSD.

(b) Whether it is at least as likely as not (i.e., the likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's psychiatric disorder, to include unspecified trauma and stressor-related disorder and alcohol use disorder, and PTSD, originated during, or is etiologically related to, active duty service.

2. Adjudicate whether the Veteran's symptoms of generalized joint pain associated with his service-connected pulmonary sarcoidosis warrants a separate compensable rating.

Michael J. Skaltsounis

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Aquino Ramos, Carlos M.

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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