Citation Nr: 21022304 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 16-53 414A DATE: April 15, 2021 REMANDED Entitlement to service connection for sleep apnea, to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for hypertension, to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for type II diabetes mellitus, to include as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1980 to October 1988 and from February 1991 to October 1991. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in July 2013 by a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the issues on appeal for additional development in October 2020, and the requested opinions were obtained in December 2020. As such, the directives have been substantially complied with and the matter is again properly before the Board. D’Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268, 271 (1998). The Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) in January 2020. A transcript of the hearing is of record. 1. Entitlement to service connection for sleep apnea, hypertension, and diabetes mellitus. VA obtained an addendum opinion in November 2020 concerning whether the Veteran’s obesity was caused by his service connected psychiatric disability or great toe disability. VA Gen. Coun. Prec. 1-2017 (Jan. 6, 2017). However, the Veteran has additionally argued that his obesity is aggravated by his service-connected disabilities, and the Court of Appeals for Veterans Claims has expanded the 2017 General Council Opinion to require that the Board consider aggravation when raised by the record. Walsh v. Wilkie, 32 Vet. App. 300, 306 – 07 (2020). As such, an additional remand for another addendum opinion which addresses whether the Veteran’s obesity was aggravated by his service-connected psychiatric disability or right great toe disability is warranted. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from the examiner who provided the November 2020 medical opinions, or another appropriate medical professional if the examiner is unavailable. The examiner should answer the following: a) Is it at least as likely as not (a fifty percent probability or greater) that the Veteran’s obesity was aggravated by either the service-connected (1) right great toe disability or (2) psychiatric disability? b) If so, is it at least as likely as not (a fifty percent probability or greater) that the aggravation of the obesity was a substantial factor in causing the Veteran’s: 1) Sleep apnea? 2) Hypertension? 3) Type II diabetes mellitus? c) If so, is it at least as likely as not (a fifty percent probability or greater) that BUT FOR the aggravation of the obesity the Veteran would not have been diagnosed with: 1) Sleep apnea? 2) Hypertension? 3) Type II diabetes mellitus? In answering (a) through (c) above, attention is invited to invited to (1) the September 1991 separation physical noting a height of 70 inches and a weight of 216 pounds; (2) a January 2003 VA treatment record noting that the Veteran reported smoking and poor eating habits (labelled “CAPRI” – pg. 1044 – uploaded 5/28/20); (3) a March 2003 VA treatment record stating that the Veteran was obese on examination (labelled “CAPRI” – pg. 1038 – uploaded 5/28/20); (4) a January 2005 treatment record noting that the Veteran drank a 12-pack a day on off days and was not complying with medical advice (labelled “CAPRI” – pg. 1021 – uploaded 5/28/20); (5) an August 2010 private treatment record noting a height of 69 inches and a weight of 255 pounds (labelled “Medical Treatment Record - Non-Government Facility” – pg. 2 – uploaded 10/11/16); and, (6) a March 2020 private opinion from Dr. S.B. concerning the Veteran’s obesity (labelled “Medical Treatment Record - Non-Government Facility” uploaded 3/26/20). A detailed rationale for the opinion must be provided. The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as against it. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Wendell, 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.