Citation Nr: 21069959 Decision Date: 11/22/21 Archive Date: 11/22/21 DOCKET NO. 14-38 589A DATE: November 22, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1962 to August 1966. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) during a June 2019 videoconference hearing. A transcript of that hearing is associated with the claims file. This case was most recently before the Board in August 2021 when it was remanded for additional development. 1. Entitlement to service connection for obstructive sleep apnea is remanded. As noted above, this matter was remanded by the Board in August 2021 to obtain an opinion regarding the etiology of the Veteran's diagnosed obstructive sleep apnea. The requested opinion was received in September 2021. The examiner found it was less likely than not that obstructive sleep apnea was caused by or aggravated by his service-connected diabetes mellitus, Type II. In response, the Veteran's representative noted that the opinion failed to address the Veteran's other service-connected disabilities. Specifically, the Veteran's representative noted that his now service-connected heart and vascular disabilities, to include coronary artery disease and peripheral vascular disease, render it difficult for the Veteran to exercise. As such, he gained weight to the point of being obese, which has led to his obstructive sleep apnea. Although obesity is not a condition for which service connection may be granted, obesity may qualify as an "intermediate step" between a service-connected disability and another current disability. See VAOPGCPREC 1-2017; Walsh v. Wilkie, 32 Vet. App. 300 (2020). In a secondary service connection claim, a theory of obesity as an intermediate step is raised when there is some evidence in the record which draws an association or suggests a relationship between the veteran's obesity, or weight gain resulting in obesity, and a service-connected condition. Garner v. Tran, 33 Vet. App. 241 (2021). In this case, the Board finds that a theory of obesity as an intermediate step has been raised but has not been adequately addressed in a VA opinion. As such, an addendum VA medical opinion to address this deficiency and the new theory of contention is warranted. The matters are REMANDED for the following action: Obtain an addendum opinion regarding the nature and etiology of the Veteran's diagnosed obstructive sleep apnea. The claims file, to include a copy of this remand, should be available to and reviewed by the clinician. Thereafter, the clinician should respond to the following: (a.) Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's obstructive sleep apnea was caused by a service-connected disability, to include coronary artery disease and/or peripheral vascular disease. (b.) Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's obstructive sleep apnea was aggravated by a service-connected disability, to include coronary artery disease and/or peripheral vascular disease. Additionally, the examiner must provide an opinion as to the nature and etiology of the Veteran's obesity, and respond to the following: (c.) Whether it is at least as likely as not that any service-connected disability (coronary artery disease, peripheral vascular disease, and/or diabetes mellitus, Type II) caused the Veteran to become obese, or aggravated the Veteran's obesity, to include any lack of exercise resulting from the service-connected disability or disabilities. (d.) Whether it is at least as likely as not that any obesity caused by the Veteran's service-connected coronary artery disease, peripheral vascular disease, and/or diabetes mellitus, Type II, was a substantial factor in causing the Veteran's sleep apnea. (e.) Whether it is at least as likely as not that the Veteran would not have developed sleep apnea if he were not obese from his service-connected coronary artery disease, peripheral vascular disease, and/or diabetes mellitus, Type II. The examiner should provide a rationale for all opinions offered and must specifically discuss the medical research cited by the Veteran in the September 2021 Appellate Brief. A discussion of the facts and medical principles involved would be of considerable assistance to the Board. CAROLINE B. FLEMING Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Connor, 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.