Citation Nr: 21074192 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 15-35 436 DATE: December 14, 2021 REMANDED Entitlement to service connection for sarcoidosis is remanded. Entitlement to service connection for diabetes is remanded. Entitlement to service connection for cirrhosis of the liver is remanded. Entitlement to service connection for hepatitis C is remanded. REASONS FOR REMAND The Veteran, who is the appellant in this case, had service from September 1976 to December 1978. The Board previously considered this appeal in July 2021, and remanded these issues for additional development. After the development was completed, the case returned to the Board for further appellate review. However, the Board finds there was not substantial compliance with its previous remand instructions, and may not properly continue with a decision until substantial compliance is obtained. See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that there must be substantial compliance with the terms of a Court or Board remand); see also Stegall v. West, 11 Vet. App. 268, 271 (1998) (noting the Board's duty to "insure [the RO's] compliance" with the terms of its remand orders). Specifically, the VA examiner was instructed to, but did not, consider the medical literature submitted by the Veteran on the link between obesity and diabetes mellitus, hepatitis C, and sarcoidosis. Furthermore, the examiner did not adequately address each question posed in the prior Board remand. 1. Entitlement to service connection for sarcoidosis is remanded. 2. Entitlement to service connection for diabetes is remanded. 3. Entitlement to service connection for cirrhosis of the liver is remanded. 4. Entitlement to service connection for hepatitis C is remanded. The Board finds remand is again warranted so that an addendum opinion may be provided by a different examiner. In its opinion, the examiner should consider and discuss the medical literature submitted by the Veteran on the link between obesity and diabetes mellitus, hepatitis C, and sarcoidosis. The matters are REMANDED for the following action: 1. Obtain a VA addendum opinion from an examiner other than the examiner who provided the October 2020, March 2021, and September 2021 opinions for the Veteran's cirrhosis, hepatitis C, sarcoidosis, and diabetes mellitus. The claims file should be reviewed by the examiner. The examiner must opine as to the following (causation): (a.) Whether it is at least as likely as not that any of the Veteran's service-connected musculoskeletal disabilities (left ankle disorder and/or service-connected right and left bunionectomies) caused him to become obese? (b.) If so, was the Veteran's obesity, as a result of any service-connected musculoskeletal disability, a substantial factor in causing the diagnosed disability (i.e., cirrhosis, hepatitis C, sarcoidosis, and/or diabetes mellitus)? The examiner is asked to consider and discuss all relevant medical literature submitted by the Veteran regarding obesity and its relationship with each of his diagnoses for cirrhosis, hepatitis C, sarcoidosis, and diabetes mellitus. (c.) Whether the diagnosed disability (i.e., cirrhosis, hepatitis C, sarcoidosis, and diabetes mellitus) would not have occurred but for obesity caused by any service-connected musculoskeletal disability? The examiner must also opine as to the following (aggravation): (a.) Whether it is at least as likely as not that any of the Veteran's service-connected musculoskeletal disabilities (left ankle disorder and/or service-connected right and left bunionectomies) aggravated his obesity? (b.) If so, was the aggravation of obesity, as a result of any service-connected musculoskeletal disability, a substantial factor in causing the diagnosed disability (i.e., cirrhosis, hepatitis C, sarcoidosis, and/or diabetes mellitus)? The examiner is asked to consider and discuss all relevant medical literature submitted by the Veteran regarding obesity and its relationship with each of his diagnoses for cirrhosis, hepatitis C, sarcoidosis, and diabetes mellitus. (c.) Whether the diagnosed disability (i.e., cirrhosis, hepatitis C, sarcoidosis, and diabetes mellitus) would not have occurred but for obesity aggravated by any service-connected musculoskeletal disability? The need for an examination is left to the discretion of the examiner. The examiner must provide a complete rationale for his or her opinion(s) in the examination report. H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Connally, 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.