Citation Nr: 19144875 Decision Date: 06/11/19 Archive Date: 06/10/19 DOCKET NO. 18-25 565 DATE: June 11, 2019 REMANDED Entitlement to service connection for hypertension as secondary to service-connected obstructive sleep apnea is remanded. Entitlement to service connection for diabetes mellitus as secondary to service-connected obstructive sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from February 1980 to February 1983 and from November 1990 to January 1991. 1. Entitlement to service connection for hypertension as secondary to service-connected obstructive sleep apnea is remanded. The Veteran seeks entitlement to service connection for hypertension. He asserts that his hypertension is secondary to his service-connected obstructive sleep apnea. In support of his claim, the Veteran has submitted a November 2014 private medical statement, which referred to but did not identify studies that support an association between sleep apnea and hypertension. The Veteran’s representative has cited to medical literature that supports an association between obstructive sleep apnea and hypertension. A remand is needed to obtain a VA medical opinion on whether the Veteran’s hypertension is proximately caused or aggravated by his service-connected obstructive sleep apnea. 2. Entitlement to service connection for diabetes mellitus as secondary to service-connected obstructive sleep apnea is remanded. The Veteran seeks entitlement to service connection for diabetes mellitus. He asserts that his diabetes mellitus is secondary to his service-connected obstructive sleep apnea. In support of his claim, the Veteran has submitted a November 2014 private medical statement which referred to studies that support an association between sleep apnea and diabetes mellitus but did not but did not identify the studies. The Veteran’s representative has cited to medical literature that supports an association between obstructive sleep apnea and diabetes mellitus. A remand is needed to obtain a new VA medical opinion that considers the private medical statement and medical literature in whether the Veteran’s diabetes mellitus is secondary to his service-connected obstructive sleep apnea. In addition, the Board notes that the March 2014 VA examiner identified the Veteran’s obesity as a risk factor for his development of diabetes mellitus. VA has already conceded that Veteran’s obesity is a result of medication that he uses to treat his service-connected depression disability. See March 2012 Board decision granting service connection for obstructive sleep apnea as secondary to depressive disability. Obesity itself is not a disability that can be compensated by VA. See Marcelino v. Shulkin, No. 16-2149, 2018 U.S. App. Vet. Claims LEXIS 64 (Vet. App. Jan. 23, 2018). Obesity can be an “intermediate step” between a current disability and a service-connected disability if it is found that the service-connected disability caused the veteran to become obese, the obesity was a substantial factor in causing the claimed secondary disability, and the claimed secondary disability would not have occurred but for obesity caused by the service-connected disability. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for pertinent treatment records from Dr. W.L. Make two requests for the authorized records from identified provider, unless it is clear after the first request that a second request would be futile. 2. Obtain any updated VA treatment records of the Veteran, from December 2013 to the present, and associate them with the claims file. 3. Schedule the Veteran for an examination to determine the etiology of his hypertension. The examiner must opine whether it is at least as likely as not proximately due to service-connected disability or aggravated beyond its natural progression by service-connected disability. In doing so, the VA examiner is asked to consider the November 2014 private medical statement as well as medical literature referenced in the April 2019 Informal Hearing Presentation. (Continued on the next page)   4. Obtain an addendum opinion regarding whether the Veteran’s diabetes mellitus is at least as likely as not proximately due to service-connected disability or aggravated beyond its natural progression by service-connected disability. In doing so, the VA examiner is asked to consider the November 2014 private medical statement as well as medical literature referenced in the April 2019 Informal Hearing Presentation. The VA examiner is also asked to answer whether the Veteran’s diabetes mellitus would not have occurred but for the obesity caused by the medication used to treat his service-connected depression disability? K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Murray, 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.