Citation Nr: 21026096 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 15-13 075 DATE: April 29, 2021 REMANDED 1. Entitlement to service connection for sleep apnea, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. 2. Entitlement to service connection for xerosis (skin rash), to include as secondary to PTSD, is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1987 to May 1991. The Veteran testified before a Veterans Law Judge in an April 2018 hearing. A transcript is of record. In January 2021, the Board notified the Veteran that the Veterans Law Judge who presided over his April 2018 hearing had retired and offered the Veteran the opportunity to appear at another Board hearing. VA rules require that a Veterans Law Judge who conducts a hearing on an appeal must participate in any decision made on that appeal. 38 U.S.C. § 7107 (c); 38 C.F.R. § 20.717. The January 2021 correspondence requested that the Veteran return his response within 30 days from the date of the letter, and if he did not respond, then the Board would assume that he did not want another hearing and would proceed accordingly. No response was received from the Veteran, and the Board will proceed with adjudication of these claims. These issues were previously before the Board in September 2018 and September 2020, at which time they were remanded for further development. Entitlement to service connection for sleep apnea, to include as secondary to PTSD, is remanded. The Veteran has asserted that his PTSD has caused or aggravated his excessive weight, which then led to a sleep apnea disability. The September 2020 Board decision remanded the issue and directed that a VA examiner provide an opinion as to whether it was at least as likely as not that the Veteran’s current excessive weight was proximately due to, the result of, or aggravated by his PTSD. The examiner was directed to consider and discuss the Veteran’s lay statements and relevant medical evidence, including an August 1999 VA mental health treatment record indicating that the Veteran reported variable appetite from no appetite to binging; a June 2011 VA treatment record in which he reported to being an “emotional eater;” and the Veteran’s statement in his March 2015 VA Form 9 that his PTSD causes him to eat and drink. The Board notes that, although obesity itself is not considered a disability for VA purposes, when obesity has been caused by a service-connected condition, and subsequently causes another disability, obesity may be considered an “intermediate step” for establishing service connection on a secondary basis. See VAOPGCPREC 1-2017 (January 6, 2017). A VA addendum opinion was obtained in October 2020. Upon review of the claims file, the examiner opined that it was less likely than not that the Veteran’s excessive weight was proximately due to or aggravated by his PTSD. The examiner noted that there are multifactorial causes for excessive weight or excessive weight gain including the result of a poor diet, excessive calorie intake, and a lack of physical activity or exercise. She noted that not every person diagnosed with PTSD was overweight and that not every overweight individual had PTSD. She also that PTSD could limit the desire to exercise or maintain a healthy diet but that this did not necessarily lead to weight gain. The Board finds that the examiner’s rationale is inadequate as she provided overly broad rationale without taking into consideration the specific facts of the Veteran’s case to support her opinions. Indeed, she did not discuss any of the Veteran’s lay statements or relevant medical evidence of record indicating that the Veteran had a variable appetite from no appetite to binging and that he had reported being an emotional eater and that his PTSD caused him to eat and drink. A medical opinion that provides no rationale or an incomplete analysis is not adequate to decide a claim. Stefl v. Nicholson, 21 Vet. App. 120 (2007). Furthermore, when VA undertakes to provide an examination or opinion, it must ensure that it is adequate. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Based on the foregoing, the Board finds that a remand is necessary in order to obtain an adequate medical opinion. Entitlement to service connection for xerosis (skin rash), to include as secondary to PTSD, is remanded. The September 2020 Board decision remanded the issue of entitlement to service connection for xerosis as inextricably intertwined with the Veteran’s assertions that his obesity was proximately due to or aggravated by his PTSD. The Board noted that a May 2020 VA examiner noted that the Veteran’s morbid obesity is a factor for his xerosis condition. Further, the Board noted that in his March 2015 VA Form 9, the Veteran reported that his VA treatment provider stated his skin problems on his legs may be due to being overweight. Remand is required so that an opinion may be obtained that addressing the Veteran’s assertion that his obesity has been caused and/or aggravated by his PTSD, which has then led to a xerosis disability. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s sleep apnea disability is at least as likely as not (50 percent or greater) proximately due to or aggravated beyond its natural progression by his service-connected PTSD. If the clinician determines that an in-person examination is necessary, such should be scheduled. In answering the above question, the examiner should address whether it is at least as likely as not that obesity served as an “intermediate step” between the PTSD disability and sleep apnea disability, answering these questions: (a.) Is it at least as likely as not that the Veteran’s PTSD caused the Veteran to become obese? (b.) If so, was the obesity that resulted from the PTSD disability a substantial factor in causing the sleep apnea disability? (c.) Would the sleep apnea disability not have occurred, but for the obesity caused by the service-connected PTSD? In answering these questions, the clinician should consider and discuss the Veteran’s lay statements and relevant medical evidence, including the August 1999 VA mental health treatment record indicating that the Veteran reported variable appetite from no appetite to binging; the June 2011 VA treatment record in which he reported to being an “emotional eater;” and the Veteran’s statement in his March 2015 VA Form 9 that his PTSD causes him to eat and drink. All opinions obtained should be supported by a medical explanation or rationale. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s xerosis disability is at least as likely as not proximately due to or aggravated beyond its natural progression by his service-connected PTSD. If the clinician determines that an in-person examination is necessary, such should be scheduled. In answering the above question, the examiner should address whether it is at least as likely as not that obesity served as an “intermediate step” between the PTSD disability and xerosis disability, answering these questions: (a.) Is it at least as likely as not that the Veteran’s PTSD caused the Veteran to become obese? (b.) If so, was the obesity that resulted from the PTSD disability a substantial factor in causing the xerosis disability? (c.) Would the xerosis disability not have occurred, but for the obesity caused by the service-connected PTSD? In answering these questions, the clinician should consider and discuss the Veteran’s lay statements and relevant medical evidence, including the August 1999 VA mental health treatment record indicating that the Veteran reported variable appetite from no appetite to binging; the June 2011 VA treatment record in which he reported to being an “emotional eater;” and the Veteran’s statement in his March 2015 VA Form 9 that his PTSD causes him to eat and drink. All opinions obtained should be supported by a medical explanation or rationale. 3. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. If the benefit sought 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. Jenna Brant Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Bristow Williams, 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.