Citation Nr: 21003852 Decision Date: 01/25/21 Archive Date: 01/25/21 DOCKET NO. 14-22 200 DATE: January 25, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to a service-connected disability, is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Army from June 1968 to March 1971, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) which is the Agency of Original Jurisdiction (AOJ). This matter was previously before the Board in February 2016 and May 2019, when it was remanded to allow VA to fulfill its duty to assist the Veteran. The Board’s prior remand directives and the subsequent actions of the AOJ will be discussed below. The Veteran’s appeal has been returned to the Board for further appellate consideration. Entitlement to service connection for hypertension, to include as secondary to a service-connected disability, is remanded. While the Board sincerely regrets further delay, additional development is required before the Veteran’s claim may be adjudicated on the merits. A new medical opinion is necessary to address whether the Veteran’s hypertension can be service connected as secondary to a service-connected disability, including the possibility of through the “intermediate step” of obesity. The Board acknowledges that it is VA’s longstanding policy that obesity per se is not, in and of itself, a disease or injury for VA compensation purposes, and therefore may not be service connected. See VAOPGCPREC 1-2017. However, the Board further acknowledges that the United States Court of Appeals for Veterans Claims (CAVC) issued a recent decision in Walsh v. Wilkie, 32 Vet. App. 300 (2020), holding that obesity as an “intermediate step” in a causal chain for service connection can be established on either a causal or aggravation basis. Although the Board does not acknowledge obesity as a disease or injury for VA compensation purposes, obesity may be used to link a currently service-connected disability to a secondary service-connected disability. Id. The Veteran’s medical records note that the Veteran has a diagnosis of obesity. A VA medical opinion is therefore necessary to determine if the Veteran’s diagnosed obesity is an intermediate step between any of the Veteran’s service-connected disabilities and the Veteran’s hypertension. Further, the Board finds that the VA medical nexus opinions associated with the claim are inadequate to address the issue of secondary service connection, specifically whether the Veteran’s service-connected disabilities aggravate the Veteran’s hypertension. The January 2020 examiner was not specifically asked to address the secondary service connection theory. The May 2016 examiner inadequately addressed the possibility that the Veteran’s service-connected disabilities, specifically the Veteran’s service-connected prostate cancer and dysthymic disorder, claimed as depression. As the January 2019 and May 2016 VA medical nexus opinions are inadequate, the Board finds another VA nexus opinion is necessary to determine the possibility of secondary service connection. Thus, a new VA addendum medical opinion is warranted in this matter to provide a more complete rationale. Barr v. Nicholson, 21 Vet. App. 303 (2007). Since the claims file is being returned it should be updated to include any recent VA treatment records that are not of record. See 38 C.F.R. § 3.159(c)(2); see also Bell v. Derwinski, 2 Vet. App. 611(1992). The matters are REMANDED for the following action: 1. Obtain all outstanding VA and private treatment records. 2. After obtaining any additional records, obtain a medical opinion regarding service connection through an intermediate step, the examiner should provide an opinion as to: (a.) Whether the Veteran’s hypertension is at least as likely as not proximately due to or the result of any incident of the Veteran’s service, to include his presumed in-service exposure to an herbicide agent. (b.) Whether the Veteran’s hypertension is at least as likely as not caused by a service-connected disability. (c.) Whether the Veteran’s hypertension is at least as likely as not aggravated by a service-connected disability. (d.) Whether it is at least as likely as not that the Veteran's obesity is caused by or related to any of the Veteran's service-connected disabilities and/or medications prescribed for such. (e.) If the response to part (d) is affirmative, state whether the Veteran’s obesity resulting from any service-connected disability/disabilities was a substantial factor in causing or aggravating his hypertension. If the reviewing health care provider finds that physical examination of the Veteran and/or diagnostic testing is necessary, such should be accomplished. A complete rationale should be given for all opinions and conclusions expressed. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. SCOTT W. DALE Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. W. Morgan, 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.