Citation Nr: 21006188 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 17-63 797 DATE: February 3, 2021 REMANDED Entitlement to service connection for a back disability, to include as secondary to service-connected generalized anxiety disorder, is remanded. Entitlement to service connection for bilateral lower extremity numbness, to include as secondary to a back disability, is remanded. REASONS FOR REMAND The Veteran had active service from July 1989 to July 1993. These matters were previously before the Board and were remanded in a July 2019 decision for further development. This development has been completed and the matters are again before the Board. The Board regrets the delay, but finds another remand is warranted. There is ample evidence to suggest the Veteran’s back condition pre-existed his time in service. However, the Veteran has also raised another theory of entitlement. The Veteran has said that his service-connected anxiety disorder has aggravated his back condition. Specifically, the Veteran has said that his anxiety disorder caused him to be unable to leave the house or exercise, which led to significant weight gain, which exacerbated his back problems. The July 2019 Board remand declined to entertain this theory of entitlement, saying this “conclusory generalized statement of a causal connection between a service-connected psychiatric disorder leading to obesity alone does not trigger VA’s duty to provide medical examination as to this theory.” Since the previous Board decision, the law surrounding obesity has changed. The Board notes that obesity is not considered a disease or disability for VA purposes and is not subject to service connection. See Marcelino v. Shulkin, 29 Vet. App. 155, 156 (2018). However, obesity may be an intermediate step between a service-connected disability and a current disability that may be service-connected on a secondary basis. 38 C.F.R. § 3.310; see also Walsh v. Wilkie, 32 Vet. App. 300 (2020). The Veteran is service-connected for a generalized anxiety disorder and he has not been afforded an examination for his above-discussed theory of entitlement. Additionally, a March 2015 examiner noted that obesity may be a risk factor for the Veteran’s type of back condition. Therefore, the Board finds another remand is warranted. The Board finds a remand is also required in the Veteran’s claim to service connection for left and right lower extremity numbness because it is inextricably intertwined with his claim to service connection for a back disability. See Harris v. Derwinski¸1 Vet. App. 180, 193 (1991). The matters are REMANDED for the following action: 1. Obtain any outstanding records pertinent to the Veteran’s claims, to include updated VA and private treatment records. The Veteran himself is encouraged to submit these records. 2. After the record is determined to be complete, obtain a medical opinion from an appropriate examiner regarding the nature and etiology of the Veteran’s back disability and his bilateral lower extremity numbness. The examiner should review the Veteran’s file and 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 obesity has been caused by his service-connected psychiatric disability? (b) Is there any medical reason to accept or reject the proposition that, had the Veteran experienced a history of being unable to leave his house and being unable to exercise, such events could have caused his obesity? (c) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s obesity has been aggravated (increased in severity) by his service-connected psychiatric disability? (d) If, and only if, the Veteran’s obesity is deemed to have been caused or aggravated by his service-connected psychiatric disability, please explain whether it is at least as likely as not the Veteran’s obesity aggravated his pre-existing back disability? (e) If, and only if, the examiner finds the Veteran’s obesity aggravated his pre-existing back disability, the examiner should explain whether it is at least as likely as not the Veteran’s bilateral lower extremity numbness is proximately due to his back disability. The VA examiner should note that the Veteran has established VA-recognized service-connected status for a generalized anxiety disorder. The VA examiner should also note that the Veteran’s obesity is not a disease or disability for VA benefits purposes; however, it may act as an intermediate step between a service-connected disability and a current disability that may be service-connected on a secondary basis. To determine whether any weight gain or obesity is an intermediate step between the Veteran’s service-connected psychiatric disabilities and a back disability, the examiner should fully answer the above questions. A full rationale is to be provided for all stated medical opinions. If an opinion cannot be made without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. 3. After the above development, and any additionally indicated development, has been completed, readjudicate the inextricably intertwined issues of entitlement to service connection for bilateral lower extremity numbness. If any benefit sought on appeal is not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. John J. Crowley Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Snoparsky 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.