Citation Nr: 20041933 Decision Date: 06/19/20 Archive Date: 06/19/20 DOCKET NO. 16-08 917 DATE: June 19, 2020 REMANDED Entitlement to service connection for a neurological condition of the left upper extremity is remanded. Entitlement to service connection for a neurological condition of the right upper extremity is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1967 to November 1969. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a June 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). These matters were previously before the Board and remanded in November 2017 and May 2018. Unfortunately, the Board finds that another remand is required before these matters can be adjudicated. 1. Entitlement to service connection for a neurological condition of the left upper extremity is remanded. 2. Entitlement to service connection for a neurological condition of the right upper extremity is remanded. In a May 2018 remand, the Board requested a VA medical examiner to opine whether any of the Veteran’s service-connected disabilities caused the Veteran to become obese, whether obesity was a substantial factor in causing the Veteran’s carpal tunnel syndrome, and whether the Veteran would have developed bilateral carpal tunnel syndrome but for the Veteran’s obesity. The RO obtained a medical opinion in June 2019. Unfortunately, the June 2019 VA medical opinion only addressed whether the Veteran’s service-connected diabetes caused the Veteran to become obese. As the medical opinion only addressed the Veteran’s service-connected diabetes and not his other service-connected disabilities, the Board finds that the June 2019 VA medical opinion did not substantially comply with the Board’s May 2018 remand instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998). At the outset, obesity is not considered a disease or disability for VA purposes and is not subject to service connection. See Marcelino v. Shulkin, 29 Vet. App. 155 (2018). However, VAOPGCPREC 1-2017 recognizes that obesity may act as an “intermediate step” between a service-connected disability and a current disability that may be service-connected on a secondary basis under 38 C.F.R. § 3.310 (a). In order to meet this criterion, the Veteran must demonstrate that a previously service-connected disability caused the Veteran to become obese; that obesity was a substantial factor in causing the secondary disability; and the secondary disability would only have occurred but for the obesity. VAOPGCPREC 1-2017 (January 6, 2017). On remand, the Board should obtain another VA medical opinion which substantially complies with the Board’s remand instructions and incorporates the requirements of the General Counsel opinion. The matters are REMANDED for the following action: 1. Obtain a VA medical opinion and request that the examiner address the following questions: a) The Veteran is service-connected for a psychiatric disability, prostate cancer, diabetic peripheral neuropathy of the lower extremities bilaterally, diabetes mellitus, bilateral hearing loss, tinnitus, and bilateral primary open-angle glaucoma. Is it at least as likely as not that any of the Veteran’s previously service-connected disabilities either caused or aggravated the Veteran’s obesity? b) If so, is it at least as likely as not that the Veteran’s obesity was a substantial factor in causing the Veteran’s carpal tunnel syndrome of the bilateral upper extremities? c) Is it at least as likely as not that that the Veteran’s carpal tunnel syndrome of the bilateral upper extremities would have occurred but for the Veteran’s obesity? A thorough rationale is required for all opinions. J. B. FREEMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Boal, Associate 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.