Citation Nr: 21074624 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 17-42 178 DATE: December 15, 2021 REMANDED Service connection for a respiratory disability to include chronic obstructive pulmonary disorder (COPD) is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Navy from February 1957 to February 1977. These matters come to the Board of Veterans' Appeals (Board) on appeal from an October 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This appeal is being adjudicated under the legacy appellate framework. The Veteran testified at a personal hearing before the Board in April 2019, and a transcript of the hearing is of record. The Board notes that these matters were previously before the Board, and, in September 2019, July 2020, and in May 2021, the Board remanded this matter for further development. Unfortunately, further development is necessary prior to adjudicating this matter. Service connection for a respiratory disability to include COPD is remanded. At issue is whether the Veteran is entitled to service connection for a respiratory disability to include COPD. Unfortunately, this matter must be remanded for a new VA examination. In May 2021, the Board remanded this matter for a new VA examination in order to discuss a number of issues including: whether the Veteran's service-connected disabilities caused the Veteran to become obese; whether the Veteran's obesity caused the Veteran to develop a respiratory disability; and whether but for the Veteran's obesity the Veteran would not have developed COPD. The Veteran was provided an examination in September 2021, but the examiner opined that an opinion of the effects of the Veteran's obesity was not necessary; because the Veteran was not obese. The examiner's opinion was based on the fact that the medical definition of obesity is an individual with a body mass index (BMI) of 30 or greater, and that the Veteran's medical literature indicated that the Veteran's BMI ranged from 23 to 28. Nevertheless, a BMI ranging from 25 to 29.9 is still associated with being overweight and thus an increased chance of disease. See MedlinePlus Medical Encyclopedia https://medlineplus.gov/ency/article/007196.htm (last visited December 8, 2021). Ultimately, what the Board must assess is whether the Veteran's previously service-connected disabilities led to weight gain and whether that weight gain caused the Veteran's claimed respiratory disability; regardless of whether or not the Veteran's weight gain does or does not technically meet the medical definition of obesity. Therefore, this matter must be remanded for a new VA examination in order to ensure substantial compliance with the Board's remand instructions. Stegall v. West, 11 Vet. App. 268 (1998). Additionally, the Board notes that the examiner indicated that the Veteran's respiratory disability was likely due at least in part to tobacco use. Tobacco use, like obesity, may serve as a linking condition between a previously service-connected disability and a secondary disability. VAOPGCPREC 6-2003 (October 28, 2003). Once VA undertakes the effort to provide the Veteran with a VA examination, it must provide the Veteran with an adequate one, and an adequate examination is sufficiently detailed in order to ensure that VA's evaluation of the Veteran's claim is fully formed. Barr v. Nicholson, 21 Vet. App. 303 (2007). Therefore, this matter must be remanded in order to address this matter in a VA examination as well. The matters are REMANDED for the following action: Arrange to provide the Veteran with a VA examination in order to address the following: (a.) Is it at least as likely as not (50 percent or more) that a medical nexus exists between an in-service incurrence and a current disability? Why or why not? (b.) Is it at least as likely as not (50 percent or more) that the Veteran's previously service-connected disabilities caused the Veteran to become obese, overweight, or any degree of weight gain? Why or why not? (c.) What is the medical significance, if any, of the Veteran's history of a BMI associated with being overweight (BMI of 25-29.9)? Why? (d.) Is it at least as likely as not (50 percent or more) that any period of being obese, being overweight, or having a noticeable degree of weight gain was a substantial factor in the Veteran developing a respiratory disability to include COPD? Why or why not? (e.) Is it at least as likely as not (50 percent or more) that but for the Veteran's period of being obese, being overweight, or having a noticeable degree of weight gain the Veteran would not have developed a respiratory disability to include COPD. (f.) As the Veteran to describe his history of tobacco use in his own words specifically what got him to start using tobacco, what got him to continue to use tobacco, and, if applicable, what got him to stop using tobacco. (g.) Is it at least as likely as not (50 percent or more) any of the Veteran's previously service-connected disabilities cause the Veteran to use tobacco products after a period of service? Why or why not? (h.) Is it at least as likely as not (50 percent or more) that the Veteran's tobacco use was a substantial factor in the Veteran developing a respiratory disability to include COPD? Why or why not? (i.) Is it at least as likely as not (50 percent or more) that but for the Veteran's tobacco use the Veteran would not have developed a respiratory disability to include COPD? Why or why not? DAVID L. WIGHT Veterans Law Judge Board of Veterans' Appeals Attorney for the Board David R. Seaton, 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.