Citation Nr: 21076830 Decision Date: 12/28/21 Archive Date: 12/27/21 DOCKET NO. 08-33 370 DATE: December 28, 2021 REMANDED Service connection for a back disability is remanded. Service connection for a left knee disability is remanded. Special monthly compensation based on the need for aid and attendance, or housebound status (SMC A&A/HB) is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Army from December 1990 to June 1991 and from December 2003 to November 2005. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a September 2006 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). This appeal is being adjudicated under the legacy appellate framework. The Veteran did not request a personal hearing before the Board. These matters were previously before the Board, and, in July 2020, the Board remanded these matters for further development. The Board notes that, in addition to the issues listed above, the Board remanded the issues of entitlement to service connection for sleep apnea for further development. In September 2021 however, VA granted service connection for sleep apnea. This is considered a full grant of the Veteran's request prayer of relief, and the Board shall not address this matter any further. 1. Service connection for a back disability is remanded. 2. Service connection for a left knee disability is remanded. At issue is whether the Veteran is entitled to service connection for a back disability and a left knee disability. The Veteran's treatment records indicate that the Veteran has a current diagnosis of a back disability and a left knee disability, but the Veteran's treatment records also indicate that the Veteran has been diagnosed with morbid obesity. The Veteran has been granted service connection for a number of disabilities potentially related to the Veteran's obesity including: posttraumatic stress disorder (PTSD), fibromyalgia, diabetic peripheral neuropathy of the bilateral lower extremities, and a right knee disability. See October 2021 Rating Decision Code Sheet. Service connection may be granted when obesity serves as a linking condition between a previously service-connected disability and a secondary disability. VAOPCGPREC 1-2017 (January 6, 2017). The Veteran has been granted multiple VA examinations during the period on appeal, but these examinations do not address this possibility. Once VA undertakes the effort to provide the Veteran with an 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 claim is fully formed. Barr v. Nicholson, 21 Vet. App. 303 (2007). Therefore, this matter must be remanded for another VA examination in order to address the above concerns. 3. SMC A&A/HB is remanded. SMC A&A/HB is inextricably intertwined with the above issues, and it must be remanded as well in order to avoid piecemeal appellate litigation. Harris v. Derwinski, 1 Vet. App. 180 (1991). 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 the Veteran's previously service-connected disabilities caused the Veteran to become obese? Why or why not? (b.) If not, then what did cause the Veteran to become obese? Why? (c.) Is it at least as likely as not (50 percent or more) that obesity was a substantial factor in the Veteran developing a back disability? Why or why not? (d.) Is it at least as likely as not (50 percent or more) that obesity was a substantial factor in the Veteran developing a left knee disability? Why or why not? (e.) Is it at least as likely as not (50 percent or more) that but for the Veteran's obesity the Veteran would not have developed a back disability? Why or why not? (f.) What did cause the Veteran to develop a back disability? Why? (g.) Is it at least as likely as not (50 percent or more) that but for the Veteran's obesity the Veteran would not have developed a left knee disability? Why or why not? (h.) What did cause the Veteran to develop a left knee disability? Why? 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.