Citation Nr: 21061647 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 14-28 345 DATE: October 4, 2021 REMANDED Entitlement to service connection for diabetes mellitus, type II, with peripheral neuropathy is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for coronary artery disease (CAD), to include as secondary to hypertension, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 1953 to October 1956. The Veteran testified at a Board hearing before the undersigned Veterans Law Judge in July 2017. A transcript of the hearing has been associated with the claims file. These issues were denied by the Board in a February 2020 decision. However, after timely appealing the decision to the United States Court of Veterans Claims (Court), the Court entered an order granting the parties' joint motion for partial remand in November 2020. These claims were thereafter remanded by the Board in May 2021; they now return to the Board. 1. Entitlement to service connection for diabetes mellitus, type II, with peripheral neuropathy is remanded. 2. Entitlement to service connection for hypertension is remanded. 3. Entitlement to service connection for CAD, to include as secondary to hypertension, is remanded. Obesity is not generally considered to be a disease or injury and therefore may not be directly connected to service. See VAOPGCPREC 1-2017 (Jan. 6, 2017). However, VA's Office of General Counsel has opined 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). Id. In order to establish service connection on this basis, three criteria must be met: (1) the service-connected disease caused the veteran to become obese; (2) such obesity is a substantial factor in causing the disability for which service connection is sought; and (3) the disability for which service connection is sought would not have occurred but for obesity. Id. The Court in Walsh v. Wilkie 32 Vet. App. 300, 307 (2020) has clarified that VA must "consider aggravation in when inquiring as to whether a service-connected disability aggravates a veteran's obesity when the theory is explicitly raised by the veteran or reasonably raised by the record." Indeed, the basis for the parties' joint motion for partial remand was that the December 2017 VA examination failed to opine whether the Veteran's service-connected disabilities caused or aggravated his obesity. Regarding the first prong above, the June 2021 VA examiner opined that it is less likely than not that the Veteran's service-connected disabilities, to include prescribed medications, caused the Veteran to become obese. The examiner reasoned that "there is no definitive proof in his chart or information in the pertinent medical literature that proves these disabilities or treatment for such caused his obesity." The examiner explained that there are several causes for obesity, including a sedentary lifestyle and increased caloric intake, but that "there is no proof in this file that his lifestyle was sedentary solely due to his" service-connected disabilities. The examiner added that since the Veteran was obese since 1958, his obesity "preceded his severe activity preclusions by many years and therefore obesity likely was not caused by activity preclusions caused by his [service-connected] medical conditions." Unfortunately, remand is necessary to obtain an addendum opinion as the June 2021 examiner did not consider whether the Veteran's service-connected disabilities aggravated his obesity as required by Walsh v. Wilkie, 32 Vet. App. 300, 307 (2020). Furthermore, the Board notes that the June 2021 VA examiner did not find that the Veteran's lifestyle became sedentary "solely due to" service-connected disabilities. But necessarily implied in that statement is that the Veteran's service-connected disabilities impacted his lifestyle in some way, and therefore contributed to his obesity, in either a causative or aggravative manner. This contradiction must be clarified upon remand. For these reasons, remand is required to obtain an addendum VA opinion. The matters are REMANDED for the following action: Obtain an addendum VA opinion, or a new VA examination if necessary, by an appropriate clinician to opine whether the Veteran's obesity is an intermediate step between his service-connected disabilities and diabetes mellitus, type II, with peripheral neuropathy, hypertension, and CAD. Specifically, the examiner must opine as to whether is at least as likely as not that: (a.) The Veteran's service-connected disabilities, to include prescribed medication for their treatment, caused the Veteran's obesity; (b.) The Veteran's service-connected disabilities, to include prescribed medication for their treatment, aggravated the Veteran's obesity; and (c.) Such obesity was a substantial factor in causing his diabetes, hypertension, or CAD; and (d.) His current diabetes mellitus, hypertension, or CAD would not have occurred but for obesity. The examiner must also provide a well-reasoned opinion as to whether it is at least as likely as not that: (a) The Veteran's CAD was caused by hypertension; or (b) The Veteran's CAD was aggravated beyond its natural progression by hypertension. The Board notes that the Veteran is service connected for major depressive disorder, headaches, a left scapula disorder, lumbar and spine disorders, radiculopathy of the bilateral lower extremities, voiding dysfunction, hemorrhoids, and left arm numbness. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Finelli, 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.