Citation Nr: 21021620 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 17-25 886 DATE: April 13, 2021 REMANDED Entitlement to service connection for erectile dysfunction, to include as secondary to the Veteran’s service-connected psychiatric disability, is remanded. Entitlement to service connection for gout in feet, to include as secondary to the Veteran’s service-connected psychiatric disability, is remanded. Entitlement to service connection for a cervical spinal disc condition, to include as secondary to the Veteran’s service-connected psychiatric disability, is remanded. Entitlement to service connection for a low back condition, to include as secondary to a neck disability and/or the Veteran’s service-connected psychiatric disability, is remanded. Entitlement to service connection for bilateral pes planus, to include as secondary to the Veteran’s service-connected psychiatric disability, is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities, is remanded. REASONS FOR REMAND This appeal has been advanced on the Board’s docket pursuant to 38C.F.R. §20.900(c). 38U.S.C. §7101(a)(2). The Veteran served on active duty from June 1959 to January 1964. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2017 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The issues were last remanded in August 2020 for additional development. Regrettably, additional development is necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to Service Connection for Erectile Dysfunction, Gout in Feet, a Cervical Disc Condition, a Low Back Condition, Bilateral Pes Planus and TDIU is Remanded. In August 2020, the issues on appeal were remanded in part to obtain medical opinions as to the etiology of the Veteran’s erectile dysfunction, gout, cervical and low back conditions, and pes planus. Amongst the Veteran’s contentions is that his obesity is caused by, or aggravated by his service-connected psychiatric disability and that it played an intermediate step in causing or aggravating the remanded disorders. In 2017, VA General Counsel determined that a service-connected disability might be the proximate cause of another disability in cases where obesity, which is not a condition for which service-connection can be granted, serves as an intermediary step between the service-connected disability and the claimed disability. VAOPGCPREC 1-2017. VA defines proximate cause as a cause that directly produces an event and without which the event would not have occurred. VAOPGCPREC 1-2017 (relying on past General Counsel precedential decisions and Black's Law Dictionary, 7th ed. 1999). VA further clarifies that "[w]hen there are multiple causes of a harm, an action is considered to be a proximate cause of the harm if it is a substantial factor in bringing about the harm and the harm would not have occurred but for the action." VAOPGCPREC1-2017 (citing Shyface v. Sec'y of Health & Human Svs., 165 F.3d 1344, 1352 (Fed. Cir. 1999)). VA has also determined that the question of proximate cause is basically one of fact for adjudication personnel to decide. VAOPGCPREC1-2017. This theory of entitlement based on an intermediary step has also been extended by the Court to claims based on aggravation. See Walsh v. Wilkie, 32 Vet. App. 300 (2020). Following remand, in November 2020, a VA examiner found that the Veteran’s obesity was not caused by his mental health conditions. Additionally, in December 2020 a different examiner also found that the evidence did not demonstrate that PTSD caused obesity. However, no opinion has been provided as to whether the Veteran’s obesity was aggravated by such. Thus, a new medical opinion addressing this issue is required. As the remanded issues may have an impact on the Veteran’s claim for TDIU these issues may have an impact on the Veteran's TDIU claim and are therefore inextricably intertwined. Harris v. Derwinski, 1 Vet. App. 180 (1991). Remand of the inextricably intertwined claim is therefore required The Board by this remand makes no determination, expressed or implied, concerning the credibility of any statements on file. The matters are REMANDED for the following action: 1. Provide the claims file to an/the appropriate clinician(s) for the purpose of eliciting an opinion as to whether (a) The Veteran’s service-connected psychiatric disability, to include alcohol abuse: i. caused the Veteran to become obese or ii. aggravated the Veteran’s obesity? Both causation and aggravation must be addressed. b) if the answer to (a) is yes, was obesity was a substantial factor in causing or aggravating the erectile dysfunction, gout in feet, a cervical disc condition, a low back condition and/or bilateral pes planus? c) If so, would the Veteran's erectile dysfunction, gout in feet, a cervical disc condition, a low back condition and/or bilateral pes planus not have occurred but for obesity caused or aggravated by the service-connected disability? Each of the requested opinions above must be supported by a detailed rationale. The examiner should consider the entire claims file, and discuss the Veteran’s lay statements regarding the nature, onset, and chronicity of symptoms as well as medical articles submitted by the Veteran in support of his claim which are included in the claims file and cited in a February 5, 2021 third party correspondence. The examiner(s) is/are advised that the Veteran is competent to report symptoms, and that his reports must be considered in formulating the requested opinion. If any examiner is unable to offer a requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resorting to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 3. Then, complete any additional development deemed necessary and readjudicate the claims remaining on appeal. If any of the benefits sought are not granted in full, furnish the Veteran and his representative with a supplemental statement of the case and an opportunity to respond, and return the case to the Board. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Slovick, 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.