How the Board ruled on sarcoidosis and pulmonary fibrosis claims, 2021–2025

Sarcoidosis / pulmonary fibrosis (direct service connection)

Direct (began in or was caused by service), or theory not stated in the Board order

38.5% granted of 408 decided cases (margin of error 33.9–43.3%). 157 granted, 251 denied, 534 sent back to VA (remanded, not decided), 113 dismissed.

What convinced the Board in granted cases

• The Board granted when a private doctor's opinion cited medical literature tying sarcoidosis or pulmonary fibrosis to a specific in-service exposure, such as herbicides, firing-range metals, oil-fire smoke, or firefighting, sometimes noting no other risk factors. (4 of 6 decisions read; e.g. A24058243, A23016441, 23018274)
• Exposure was supported by the veteran's credible account of his duties, matched by his job specialty or personnel records such as a marksmanship badge. (2 of 6 decisions read, few decisions; e.g. A24003319, A24058243)
• The Board noted that no presumption for the disease did not bar a direct link, and granted when favorable and unfavorable opinions were in balance or the disease appeared within a year of discharge. (3 of 6 decisions read; e.g. A23016441, A23015645, A23015055)

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Sarcoidosis / pulmonary fibrosis (exposure claims)

Exposure (e.g. Agent Orange, Camp Lejeune, burn pits)

14.9% granted of 67 decided cases (margin of error 8.3–25.3%). 10 granted, 57 denied, 108 sent back to VA (remanded, not decided), 12 dismissed.

What convinced the Board in granted cases

• The Board favored private or treating doctors, often lung specialists, whose opinions were well reasoned and backed by medical literature tying the lung disease to the specific exposure. (6 of 13 decisions read; e.g. A23001137, A22000272, 22000835)
• VA opinions lost weight when they relied only on no symptoms in service and the time gap, focused on a single risk factor, used an incomplete history, or were conclusory. (6 of 13 decisions read; e.g. A23001137, 21067264, 22000835)
• Credible lay statements that breathing problems began in or right after service and continued since, plus conceded exposure, also supported grants. (3 of 13 decisions read; e.g. A23011314, 24008363, 21072935)

Common reasons in denied cases

• The Board denied when a reasoned VA opinion, often citing literature, found another cause more likely, most often a long smoking history or post-service exposures. (7 of 10 decisions read; e.g. 21074652, 21063940, 23046193)
• No medical professional linked the lung condition to the exposure, and the veteran's or family's own belief was not competent medical evidence. (5 of 10 decisions read; e.g. A24007822, 23040228, A21007504)
• Some denials noted the lung condition was not on the herbicide presumptive list, or found no continuity of symptoms since service. (3 of 10 decisions read; e.g. 21063940, A21007504, 21020708)

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Sarcoidosis / pulmonary fibrosis secondary to any service-connected condition

Secondary (caused or worsened by a service-connected condition)

45.9% granted of 37 decided cases (margin of error 31.0–61.6%). 17 granted, 20 denied, 77 sent back to VA (remanded, not decided), 2 dismissed.

What convinced the Board in granted cases

• The Board granted on a medical opinion that explained the mechanism, such as fibrosis from scleroderma, pulmonary hypertension from heart disease, or a clot after knee surgery, often with no contrary opinion. (8 of 12 decisions read; e.g. 21017539, 24000672, 21017863)
• A negative VA opinion lost weight when it was a general statement that did not consider all the facts, or when treating doctors or an equally reasoned private opinion pointed the other way. (3 of 12 decisions read; e.g. 23031553, A23026201, A24068469)
• Credible lay accounts of symptoms or in-service exposure, consistent with the records, supported the medical opinions. (2 of 12 decisions read, few decisions; e.g. 24000672, A22001545)

Common reasons in denied cases

• The Board denied when a thorough VA opinion that reviewed the file and explained its reasoning, often naming smoking as the more likely cause, outweighed the evidence for the claim. (7 of 14 decisions read; e.g. 22015736, A24068204, 22054608)
• Private opinions lost weight when they gave no rationale or were conclusory. (2 of 14 decisions read, few decisions; e.g. 21065322, 21019702)
• Other denials turned on no current diagnosis or on the underlying condition not being service connected. (4 of 14 decisions read; e.g. 23046902, 21050176, A24040469)

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