Citation Nr: 21025334 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 16-33 530 DATE: April 27, 2021 REMANDED Entitlement to service connection for sleep apnea, to include as due to an undiagnosed multisymptom illness, secondary to posttraumatic stress disorder (PTSD), secondary to asthma is remanded. Entitlement to a total disability rating due to induvial unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Army from January 1983 until August 1991. The Board of Veterans’ Appeals (Board) remanded the matters for further development in February 2020. 1. Entitlement to service connection for sleep apnea is remanded. The Board notes the Veteran, through his representative, raised the theory of secondary service connection due to PTSD, with obesity as an intermediate step in June 2018. The Veteran has been provided with VA examinations in November 2017 and May 2020 which collectively determined the Veteran’s sleep apnea was not related to active service, not related to service in Southwest Asia, not secondary to asthma, and not secondary to PTSD. However, no opinion has been provided which addresses whether the Veteran’s obesity was caused by PTSD. The Board observes that obesity is not considered a disease or disability for VA purposes and is not subject to service connection. 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. Walsh v. Wilkie, 32 Vet. App. 300 (2020); 38 C.F.R. § 3.310. For obesity to be considered an “intermediate step,” the evidence must show that a previously service-connected disability caused a Veteran to become obese; that obesity was a substantial factor in causing the secondary disability; and that the secondary disability would not have occurred but for the obesity. Accordingly, an addendum opinion is necessary to determine if obesity was in intermediate step between PTSD and sleep apnea. The Board also notes the Veteran’s representative requested an in-person sleep apnea examination in May 2020. 2. Entitlement to a TDIU is remanded. The Board notes an incomplete employment history provided by the Veteran. In the October 2016 TDIU application, the Veteran listed equipment operator as his last job in December 2012 in Section II.17, but the examiner reported he last worked full time in September 2016 in Section II.14. In the April 2020 TDIU application, the Veteran listed equipment operator as his last job in May 2012 in Section II.15 and Section II.17. The Veteran provided a March 2020 Vocational Assessment in which the examiner found the Veteran unable to secure and follow any substantially gainful occupation since 2013. The examiner noted the Veteran last worked as an equipment operator in 2013. A VA Form 21-4192 was provided in May 2020 from the Veteran’s former employer, which showed he worked at a call center from August 2016 to December 2016. In the December 2020 respiratory conditions VA examination, the Veteran reported currently working as a machine operator at a coal mine. The Veteran has provided differing dates for his employment history, and the record provides evidence that the Veteran is currently working. The Board emphasizes that the duty to assist is a two-way street, and the Veteran should provide VA with all the necessary information related to the Veteran’s TDIU claim. Upon remand, the Veteran should supply VA with a complete and accurate VA Form 21-8940 in order to show relevant occupational history to include his income and hours worked with any current and former forms of employment. Although the Veteran did provide a positive TDIU opinion, the vocational assessment provided an incomplete occupational history for the Veteran. The examiner’s rationale is partially based upon an incomplete history. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). The matters are REMANDED for the following action: 1. Furnish the Veteran with a 38 C.F.R. § 3.159(b) notice letter and a VA Form 21-8940 as to the TDIU claim. Request that the Veteran provide full up-to-date details. 2. Schedule the Veteran for an in-person examination by an appropriate clinician to determine the nature and etiology of any sleep apnea disability. The Veteran’s claim-file, including this REMAND, must be made available to and reviewed by the clinician. The examiner is asked to address the following: Provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s obesity has been caused by his service-connected PTSD, as well as any effects of medication used in connection with PTSD; Provide an opinion as to whether it is at least as likely as not that the Veteran’s obesity has been aggravated (increased in severity) by his service-connected PTSD, as well as any effects of medication used in connection with PTSD; and IF, the Veteran’s obesity is deemed to have been caused or aggravated by his service-connected disabilities, notably PTSD, please explain whether sleep apnea was at least as likely as not caused or aggravated by such obesity. The clinician must provide a complete rationale for the opinion and conclusion reached, citing the objective medical findings leading to the conclusion. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. N. Quarles, 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.