Citation Nr: 21004161 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 14-34 592 DATE: January 26, 2021 REMANDED Entitlement to service connection for hypertension to include as secondary to degenerative arthritis of the knees, shoulders, cervical and lumbar spine, radiculopathy associated with lumbar spine arthritis, and left knee meniscal tear, is remanded. Entitlement to service connection for type II diabetes mellitus to include as secondary to degenerative arthritis of the knees, shoulders, cervical and lumbar spine, radiculopathy associated with lumbar spine arthritis, and left knee meniscal tear, is remanded. REASONS FOR REMAND The Veteran served in active duty service with the Air Force from October 1983 to September 1991. This matter is on appeal from a February 2010 rating decision. The Veteran was afforded an August 2019 hearing before the undersigned Judge. A transcript of the hearing has been associated with the record. The Board finds that remand is warranted for additional development. At the August 2019 hearing, the Veteran’s representative asserted that the Veteran’s hypertension and diabetes resulted from weight gain caused by a decreased inability to exercise due to musculoskeletal issues and injuries during the Veteran’s service. In a November 2019 Board decision, the Board granted service connection for degenerative arthritis of the left knee and meniscal tear; degenerative arthritis of the right knee; degenerative arthritis of the right and left shoulder; degenerative arthritis of the cervical spine; degenerative arthritis of the lumbar spine with radiculopathy; and depressive disorder. The Board decision remanded the issues of entitlement to service connection for hypertension and type II diabetes mellitus to obtain an opinion on whether: (1) whether a service-connected disability caused a veteran to become obese; (2) if so, whether the obesity as a result of the service-connected disability was a substantial factor in causing the current disability for which a veteran is seeking service connection; and (3) whether the current disability for which a veteran is seeking service connection would not have occurred but for the obesity caused by the service-connected disability. The Veteran was afforded a May 2020 VA examination. The examiner opined that the Veteran’s hypertension and type II diabetes mellitus were not directly caused during service; not caused and/or aggravated by service connected disabilities; the Veteran’s service connected disabilities did not cause the Veteran to become obese; and obesity was not a substantial factor in causing hypertension and type II diabetes mellitus. The examiner found the Veteran’s service treatment records (STRs) did not show any diagnoses for hypertension or type II diabetes. The examiner listed risk factors for obesity to include dietary habits; sedentary lifestyle; genetic predisposition; advanced age decreasing muscle mass and increased fat accumulation; and lack of exercise. The examiner stated that lack of exercise was one risk factor but not a definitive risk factor. The examiner also noted that obesity was a risk factor but not a definitive risk factor in causing hypertension and diabetes mellitus. However, the Board notes while the examiner listed relevant risk factors in the causes of obesity, hypertension and diabetes mellitus, the examiner does not provide specific rationale on how the listed risk factors applied or affected the Veteran. As noted in the November 2019 Board decision, the Veteran’s STRs show documented elevated blood pressure readings in service which were not referred to or discussed by the examiner. Finally, the opinion is unclear whether the examiner opined on whether the current disability for which a veteran is seeking service connection would not have occurred but for the obesity caused by the service-connected disabilities. As such, the Board finds the opinion inadequate and did not substantially comply with the November 2019 Board remand directives. See Stegall v. West, 11 Vet. App. 268 (1998) (holding that where remand instructions are not followed, the Board errs as a matter of law when it fails to ensure compliance). Therefore, the Board finds that remand for compliance with the November 2019 Board remand instructions is warranted. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file all updated and outstanding treatment records. 2. After all outstanding records have been associated with the claims file, return the claims file to the VA examiner who provided the May 2020medical opinion on the Veteran’s hypertension and type II diabetes mellitus. The record and a copy of this remand must be made available to the examiner. If the examiner determines that an examination of the Veteran is necessary to provide the requested opinion with rationale, then such examination should be scheduled. If the May 2020 VA examiner is not available, the requested opinion with rationale should be rendered by another appropriate medical professional. The VA examiner should opine as to the following: (a.) Is it as least as likely as not (a 50 percent or greater probability) the Veteran’s hypertension arose in service or is etiologically related to his military service? The examiner should address the inservice records of elevated blood pressure readings in the Veteran’s STRs. (b.) Is it as least as likely as not (a 50 percent or greater probability) the Veteran’s diabetes mellitus arose in service or is etiologically related to his military service? The examiner should also address the following: (c.) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s service-connected degenerative arthritis of the knees, shoulders, cervical and lumbar spine, radiculopathy associated with lumbar spine arthritis, and left knee meniscal tear, caused the Veteran to become obese? (d.) Is it at least as likely as not (50% or better probability) that the obesity was a substantial factor in causing the Veteran’s hypertension? (e.) Is it at least as likely as not (50% or better probability) that the Veteran would not have hypertension if he were not obese? (f.) Is it at least as likely as not (50% or better probability) that the obesity was a substantial factor in causing the Veteran’s type II diabetes mellitus? (g.) Is it at least as likely as not (50% or better probability) that the Veteran would not have type II diabetes mellitus if he were not obese? (h.) The opinions should include a discussion of any pertinent studies or medical literature, as well as pertinent evidence on file to include the Veteran’s testimony and submitted April 2019 and August 2019 private physician statements. The examiner is also advised that the Veteran is competent to report in-service events and treatment, and his symptoms and history, and such reports and assertions must be specifically acknowledged and considered in formulating any opinions. If the examiner rejects the Veteran’s reports, the examiner must provide a reason for doing so. (i.) The examiner should provide a complete rationale for any opinions provided, and if the examiner is unable to provide any opinion request, then the examiner should state so and why. (j.) If the VA examiner is unable to provide an opinion without resort to speculation, he or she should explain whether the inability is due to the limits of the examiner’s medical knowledge, medical knowledge in general or there is evidence that, if obtained, would permit the opinion to be provided. A clearly stated rationale for any opinion offered should be provided. 3. After completion of the above and any additional development deemed necessary, the issues on appeal should be reviewed with consideration of all applicable laws and regulations. If any benefit sought remains denied, the Veteran should be furnished a supplemental statement of the case and be afforded the opportunity to respond. Thereafter, the case should be returned to the Board for appellate review. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Yang, Attorney-Advisor 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.