Citation Nr: 18141747 Decision Date: 10/11/18 Archive Date: 10/11/18 DOCKET NO. 18-24 485 DATE: October 11, 2018 REMANDED Entitlement to service connection for diabetes mellitus, type II, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from June 1972 to June 1974. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a December 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, the Commonwealth of Puerto Rico. Entitlement to service connection for diabetes mellitus, type II, is remanded. The Veteran has asserted that his diabetes developed as a result of obesity brought on by decreased physical activity due to his service-connected right ankle disability. Although service connection is not allowed for obesity on its own, obesity can act as an “intermediate step” to establish service connection for another disability as secondary to an already service-connected disability under certain circumstances. See VAOPGCPREC 1-2017. The VA General Counsel (GC) has indicated that establishing service connection in a case such as the Veteran’s requires resolution of three issues: (1) whether the service-connected disability caused the Veteran to become obese; (2) if so, whether the obesity due to the service-connected disability was a substantial factor in causing the claimed disability; and (3) whether the claimed disability would not have occurred but for obesity caused by the service-connected disability. Id. The Veteran submitted a September 2017 letter from Dr. A.A. wherein the doctor opined that the Veteran “more likely than not developed obesity secondary to his decreased activity because of his continued complication from his service-connected right ankle injury.” The doctor stated that prior to the right ankle injury, the Veteran reported that he had been an avid sportsman and community leader. The doctor noted that lack of physical activity was the greatest risk factor for obesity, and that the obesity put the Veteran at risk for development of type II diabetes. Although the private opinion is probative, it does not address all of the factors set out in the GC opinion. As such, further development for an examination and opinion is necessary. This matter is REMANDED for the following action: 1. After obtaining any necessary authorization(s), update the file with any outstanding VA and private treatment records relevant to the Veteran’s claim. If any requested records are unavailable, the Veteran should be notified. 2. After the foregoing development has been completed to the extent possible, arrange to have the Veteran scheduled for a VA examination pertaining to obesity. The examiner should review the record. All indicated tests should be conducted and the results reported. After examining the Veteran and reviewing the record, together with the results of any testing deemed necessary, the examiner should offer an opinion as to each of the following questions: (a) Is it at least as likely as not (i.e., is it 50 percent or more probable) that the Veteran’s service-connected right ankle disability caused him to become obese, whether by interfering with his ability to exercise or otherwise? (b) If so, is it at least as likely as not that the obesity due to the service-connected right ankle disability was a substantial factor in causing the Veteran’s diabetes mellitus? (c) Is it more likely than not (i.e., more than 50 percent likely) that the Veteran’s diabetes mellitus would have occurred anyway, apart from any obesity caused by his service-connected right ankle disability? A complete medical rationale for all opinions expressed must be provided. 3. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the Veteran’s claim should be readjudicated based on the entirety of the evidence. If the benefit sought remains denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. DAVID A. BRENNINGMEYER Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Smith, Associate Counsel