Citation Nr: 21014700 Decision Date: 03/15/21 Archive Date: 03/15/21 DOCKET NO. 16-31 781 DATE: March 15, 2021 REMANDED Entitlement to service connection for diabetes mellitus is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded. Entitlement to service connection for bilateral leg disability, claimed as a gait condition is remanded. Entitlement to service connection for a right shoulder disability is remanded. Entitlement to service connection for a bilateral shoulder disability is remanded. Entitlement to service connection for a neck disability is remanded. Entitlement to service connection for a lower back disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded. REASONS FOR REMAND The Veteran served in the Army Reserves from February 1, 1975 to January 31, 1978 with active duty for training (ACDUTRA) from May 1975 to June 1975. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a June 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In April 2019, the Appellant appeared and testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the proceeding is associated with the claims file. In an October 2019 decision, the Board denied, in part, the Veteran’s claims for service connection for right knee, lower back, left knee, diabetes mellitus, hypertension, GERD, bilateral leg, right shoulder, bilateral shoulder, and neck disabilities. The Veteran appealed this determination to the U.S. Court of Appeals for Veterans Claims (Court). In August 2020 the Court granted a Joint Motion to Modify and for Partial Remand, in which the Parties agreed to vacate that portion of the October 2019 decision denying the Veteran’s claims and remand the claims for further development. In addition, the October 2019 Board decision was modified to reflect that the issue of service connection for hypothyroidism was remanded rather than denied. During the pendency of the appeal in a September 2020 decision, the Board denied entitlement to service connection for hypothyroidism. Thus, the hypothyroidism claim is no longer before the Board. 1. Entitlement to service connection for diabetes mellitus is remanded. 2. Entitlement to service connection for hypertension is remanded. 3. Entitlement to service connection for GERD is remanded. 4. Entitlement to service connection for bilateral leg disability, claimed as a gait condition, is remanded. 5. Entitlement to service connection for a right shoulder disability is remanded. 6. Entitlement to service connection for a bilateral shoulder disability is remanded. 7. Entitlement to service connection for a neck disability is remanded. 8. Entitlement to service connection for a lower back disability is remanded. 9. Entitlement to service connection for a left knee disability is remanded. 10. Entitlement to service connection for a right knee disability is remanded. The Veteran claims that her diabetes mellitus, hypertension, GERD, bilateral leg, right shoulder, bilateral shoulder, neck, lower back, right and left knee disabilities are secondary to her service-connected PTSD. She alleges that these conditions were caused or aggravated by weight gain due to PTSD. The Board observes 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 connected on a secondary basis. 38 C.F.R. § 3.310; see also Walsh v. Wilkie, 32 Vet. App. 300 (2020). As stated above, these claims were denied in an October 2019 Board decision. However, in the August 2020 Joint Motion to Modify and for Partial Remand, the Parties agreed that the Board erred in not remanding these claims because they were inextricably intertwined with the claim for service connection for an acquired psychiatric disorder, which was remanded by the Board. During the pendency of the appeal, in a January 2020 rating decision, the RO granted service connection for PTSD with major depressive disorder and anxious distress, effective April 21, 2014. In support of her claim, the Veteran submitted a June 2018 private medical opinion stating that the Veteran’s PTSD resulted in her obesity, which led to the following disabilities: hypertension, diabetes, GERD, osteoarthritis of both knees, chronic back disability, and bilateral leg disability. As rationale, the physician merely stated that obesity is a well-known risk factor for these physical conditions. The Board notes that a medical opinion “must support its conclusions with an analysis that the Board can consider and weigh against contrary opinions.” See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (“most of the probative value of a medical opinion comes from its reasoning”). Given the inadequacy of the opinion, the Board finds a new medical opinion is required to make a determination on the Veteran’s claims. As such, the claims are remanded for new VA medical opinions to address theories of secondary service connection and obesity. The matters are REMANDED for the following action: 1. Arrange for an appropriate health care provider to review the Veteran’s claims file and provide an opinion as to: a) whether it is at least as likely as not, (50 percent probability or greater), that diabetes mellitus, hypertension, GERD, bilateral leg, right shoulder, bilateral shoulder, neck, lower back, and/or right and left knee disabilities were (i) caused or (ii) aggravated beyond normal progression by service-connected PTSD. Aggravation means an increase in disability – any additional impairment of earning capacity – of the nonservice-connected disability. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the diagnosed disability prior to aggravation by the service-connected disability. b) If not, is it at least as likely as not that (i) service-connected PTSD caused or aggravated the Veteran’s obesity; (ii) if so, whether the obesity or the aggravation of obesity as a result of service-connected PTSD was a substantial factor in causing diabetes mellitus, hypertension, GERD, bilateral leg, right shoulder, bilateral shoulder, neck, lower back, and/or right and left knee disabilities; and (iii) whether diabetes mellitus, hypertension, GERD, bilateral leg, right shoulder, bilateral shoulder, neck, lower back, and/or right and left knee disabilities would not have occurred but for the obesity caused by service-connected PTSD or the obesity aggravated by service-connected PTSD. The Board appreciates the examiner’s patience in addressing this multistep question. If the reviewing health care provider finds that physical examination or telehealth interview of the Veteran and/or diagnostic testing is necessary, such should be accomplished. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 2. After completing the above actions, the claims must be readjudicated. If the claims remain denied, a supplemental statement of the case must be provided to the Veteran and her representative. After the Veteran and her representative have had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. M. Donohue Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Amanda Baker, 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.