Citation Nr: 21076984 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 12-09 798 DATE: December 28, 2021 REMANDED Entitlement to service connection for a left hip disability to include as due to bilateral knee disability; bilateral pes planus; and right ankle disability is remanded. REASONS FOR REMAND The Veteran served in active-duty service to include Reserve service from May 1983 to August 1983 and February 2003 to May 2004. This matter is on appeal from an August 2015 rating decision. The Board remanded this appeal in April 2017, December 2019, October 2020, and May 2021 for additional development. Unfortunately, the Board finds that remand is warranted for additional development. The Veteran has asserted service connection for a left hip disability to include as due to disabilities of the lower extremities. The Veteran is currently service connected for a bilateral knee disability; bilateral pes planus; and for a right ankle disability. In a July 2016 VA opinion, the examiner noted one of the risk factors for hip osteoarthritis included obesity. Review of the medical treatment record documents the Veteran's obesity as well its effect on the Veteran's gait. In a September 2019 Veteran statement, the Veteran noted their service-connected disabilities for bilateral pes planus and bilateral knee and stated that she had to "shift my weight back and forth for the past 15 years." The Veteran next indicated that she has been very obese for the past 20 years and attributed her obesity to medication and inability to exercise due to her service-connected conditions. The Board notes that obesity may be an intermittent step between a service-connected disability and a current disability that may be service connected on a secondary basis. VAOPGCPREC 1-2017 (Jan 6, 2017). The VA General Counsel opinion states that obesity is not a disease for service connection purposes. VAOPGCPREC 1-2017 at 1. Nonetheless, obesity may be an intermittent step between a service-connected disability and a current disability that may be service connected on a secondary basis. Id. at 2. To grant service connection, the adjudicators would have to resolve the following issues: (1) whether a service-connected disability caused a veteran to become obese; (2) if so, whether the obesity as a result of the service-connected disability was a substantial factor in causing the current disability for which a veteran is seeking service connection; and (3) whether the current disability for which a veteran is seeking service connection would not have occurred but for the obesity caused by the service-connected disability. Id. at 9-10. Review of the claims record does not show any medical opinions addressing whether a service- connected disability caused a veteran to become obese; if so, whether the obesity as a result of the service-connected disability was a substantial factor in causing the current disability for which a veteran is seeking service connection; and whether the current disability for which a veteran is seeking service connection would not have occurred but for the obesity caused by the service-connected disability. As such, the Board finds remand for a VA medical opinion to answer these questions is warranted. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file all updated and outstanding treatment records. 2. After all outstanding records have been associated with the claims file, return the claims file to the VA examiner who provided the October 2021 medical opinions on the Veteran's left hip disability. The record and a copy of this remand must be made available to the examiner. If the examiner determines that an examination of the Veteran is necessary to provide the requested opinion with rationale, then such examination should be scheduled. If the October 2021 VA examiner is not available, the requested opinion with rationale should be rendered by another appropriate medical professional. The VA examiner should opine as to the following: (a.) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's service-connected right and left knee disability; bilateral pes planus; and right ankle disability caused the Veteran to become obese? (b.) Is it at least as likely as not (50% or better probability) that the obesity was a substantial factor in causing the Veteran's left hip disability? (c.) Is it at least as likely as not (50% or better probability) that the Veteran would not have a left hip disability if the Veteran were not obese? (d.) If the examiner cannot provide the above opinions, the examiner is advised that he/she must explain why the requested opinion cannot be provided (i.e., because the limits of medical knowledge had been exhausted or because further information to assist in making the determination is needed, such as additional records and/or diagnostic studies). (e.) If the examiner cannot provide an answer because further information is needed to assist in making the determination, all reasonable steps to obtain the missing information should be exhausted before concluding that the answer cannot be provided. (f.) The examiner is also advised that the Veteran is competent to report in-service events and treatment, and the Veteran's symptoms and history, and such reports and assertions must be specifically acknowledged and considered in formulating any opinions. If the examiner rejects the Veteran's reports, the examiner must provide a reason for doing so. (g.) The examiner should provide a complete rationale for any opinions provided, and if the examiner is unable to provide any opinion request, then the examiner should state so and why. 3. After completion of the above and any additional development deemed necessary, the issues on appeal should be reviewed with consideration of all applicable laws and regulations. If any benefit sought remains denied, the Veteran should be furnished a supplemental statement of the case and be afforded the opportunity to respond. Thereafter, the case should be returned to the Board for appellate review. MICHAEL LANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Yang, Attorney-Advisor 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.