Citation Nr: 18124152
Decision Date: 08/07/18	Archive Date: 08/06/18

DOCKET NO. 15-24 270
DATE:	August 7, 2018
REMAND
Entitlement to service connection for hypertension, to include as secondary to service-connected disorders is remanded.
REASONS FOR REMAND
The Veteran served on active duty from May 1966 to February 1968. His decorations include a Purple Heart and Combat Infantryman Badge.
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in New York, New York.
Entitlement to service connection for hypertension, to include as secondary to service-connected disorders is remanded.
The Veteran was afforded a VA examination in April 2015. The examiner opined that the Veteran’s hypertension was not etiologically related to his active service, reasoning that it is caused by an independent factor (such as a high salt diet and being overweight), and not related to medications used to treat the Veteran’s psychiatric disorders or erectile dysfunction. However, this rationale does not fully address the Veteran’s allegations. 
In the March 2018 appellant brief, the Veteran’s representative asserts that the Veteran’s hypertension is due to weight gain caused by his VA prescribed medications and service-connected psychiatric disorder. As the April 2015 VA examiner listed weight as a potential cause of the Veteran’s hypertension, an addendum opinion is necessary to clarify the etiology of the Veteran’s hypertension.  Although service connection is not permitted 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.  Marcelino v. Shulkin, 28 Vet. App. 155 (2018); VAOPGCPREC 1-2017 (Jan. 6, 2017).
The matter is REMANDED for the following action:
Obtain an addendum opinion regarding the Veteran’s hypertension (a new examination is not required unless deemed necessary). The claims folder and a copy of this remand must be made available to and reviewed by the examiner prior to completion of the medical opinion. The examiner is then asked to address the following:
1. Is it at least as likely as not (50 percent or greater probability) that the medication used to treat the Veteran’s service-connected disabilities caused the Veteran to become obese?
2.  If so, is it at least as likely as not (50 percent or greater probability) that the obesity was a substantial factor in causing hypertension?
3. If so, is it at least as likely as not (50 percent or greater probability) that the hypertension would not have occurred but for the obesity caused by medication used to treat the service-connected disabilities?
All opinions are to be accompanied by a rationale consistent with the evidence of record. A discussion of the pertinent evidence, relevant medical treatises, and generally accepted medical principles is requested.
If the examiner cannot provide an opinion without resorting to speculation, he or she shall provide complete explanations stating why this is so. In so doing, the examiner shall explain whether any inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 
 
LAURA E. COLLINS
Acting Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	E. Duthely, Associate Counsel