Citation Nr: 21068765 Decision Date: 11/12/21 Archive Date: 11/12/21 DOCKET NO. 16-34 786 DATE: November 12, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea is remanded. Entitlement to service connection for a pulmonary disease is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for vision loss, to include as secondary to hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1986 to February 1988. These matters are before the Board of Veteran's Appeals (Board) on appeal from February 2014 and April 2014 rating decisions issued by a Regional Office (RO) of the Department of Veterans Affairs (VA). As the February 2014 rating decision denying entitlement to service connection for a pulmonary disease did not become final, new and material evidence is not required. In January 2019, the Veteran testified before a Veterans Law Judge at a Board hearing. A transcript of the hearing is of record. In June 2021, the Veteran was advised that the Veterans Law Judge who conducted the hearing was no longer employed by the Board and he was offered the opportunity to testify before a different Veterans Law Judge. The Veteran did not respond to request another hearing; thus, the Board deems that the Veteran has waived his right to have another hearing and will proceed accordingly. In an April 2020 rating decision, the RO granted the appeal of entitlement to service connection for major depressive disorder. As this represents a total grant of the benefits sought on appeal, the matter is no longer before the Board. See Grantham v. Brown, 114 F. 3d 1156, 1159 (Fed. Cir. 1997). Entitlement to service connection for obstructive sleep apnea is remanded. Entitlement to service connection for a pulmonary disease is remanded. Entitlement to service connection for hypertension is remanded. The Veteran asserts that his hypertension, obstructive sleep apnea and pulmonary disease began during active service. See January 2019 Board hearing transcript. The Veteran also asserts that his hypertension, obstructive sleep apnea and pulmonary disease are due to his obesity, and that his obesity is due to his service-connected major depressive disorder. See February 2013 VA Form 21-526b, June 2019 VA-Form 9 and January 2019 Board Hearing transcript. Obesity is not a chronic disease, injury, or disability for VA purposes, and therefore may not be the basis of service connection. However, 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. The Veteran had VA examinations for these matters in February 2020. When VA undertakes to provide an exam, it must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). The appeals must be remanded in order to obtain addendum opinions regarding obesity as an "intermediate step" between the Veteran's service-connected major depressive disorder and his hypertension, obstructive sleep apnea and pulmonary disease. Further, the Veteran has specifically asserted that his pulmonary disease is due to in-service exposure to petroleum. See February 2013 VA Form 21-526b. The Veteran's DD-214 shows that he was a petroleum supply specialist, thus his exposure to petroleum is conceded. The February 2020 VA examiner did not consider the Veteran's contentions regarding his pulmonary disease as due to his petroleum exposure, thus an addendum opinion on this matter must be obtained. Entitlement to service connection for vision loss, to include as secondary to hypertension is remanded. Finally, because a decision on the remanded issue of entitlement to service connection for hypertension could significantly impact a decision on the issue of vision loss as secondary to hypertension, the issues are inextricably intertwined. A remand of the claim for enttilement to service connection for vision loss is required. The matters are REMANDED for the following action: 1. Update the Veteran's VA treatment records, to include from October 2021. 2. Obtain an addendum medical opinion regarding the Veteran's obstructive sleep apnea. The examiner is asked to address the following: (a) Whether the Veteran's the service-connected major depressive disorder caused him to become obese or aggravated his obesity; (2) if so, whether the obesity or aggravation of obesity as a result of the service-connected disabilities was a substantial factor in causing the obstructive sleep apnea; and (3) whether the obstructive sleep apnea would not have occurred but for the obesity caused or obesity aggravated by the service-connected disability. 3. Obtain addendum medical opinions regarding the Veteran's pulmonary disease. The examiner is asked to address the following: (a) Whether the Veteran's pulmonary disease is at least as likely as not related to his conceded in-service exposure to petroleum, as a petroleum supply specialist. (b) Whether the Veteran's service-connected major depressive disorder caused him to become obese or aggravated his obesity; (2) if so, whether the obesity or aggravation of obesity as a result of the service-connected disabilities was a substantial factor in causing the pulmonary disease; and (3) whether the pulmonary disease would not have occurred but for the obesity caused or obesity aggravated by the service-connected disability. 4. Obtain an addendum medical opinion regarding the Veteran's hypertension. The examiner is asked to address the following: (a) Whether the Veteran's the service-connected major depressive disorder caused him to become obese or aggravated his obesity; (2) if so, whether the obesity or aggravation of obesity as a result of the service-connected disabilities was a substantial factor in causing the hypertension; and (3) whether the hypertension would not have occurred but for the obesity caused or obesity aggravated by the service-connected disability. After the above development, and any additionally indicated development, has been completed, readjudicate the inextricably intertwined issue of entitlement to service connection for vision loss, to include as secondary to hypertension. A full rationale for all opinions must be provided. Jennifer White Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Susan Leary 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.