Citation Nr: 21029866 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 14-28 345 DATE: May 17, 2021 REMANDED Entitlement to service connection for diabetes mellitus, type II, with peripheral neuropathy is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for coronary artery disease (CAD), to include as secondary to hypertension, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 1953 to October 1956. The Veteran testified at a Board hearing before the undersigned Veterans Law Judge in July 2017. A transcript of the hearing has been associated with the claims file. These issues were denied by the Board in a February 2020 decision. In addition, the issue of entitlement to an earlier effective date for the award of special monthly compensation (SMC) was granted. The Veteran appealed the decision to the United States Court of Veterans Claims (Court). As the issue of SMC was an award of the benefit sought, the Court did not disturb or address the issue. The Court entered a joint motion for partial remand (JMPR) in November 2020 vacating the remaining issues. The claims are returned to the Board for appellate review. 1. Entitlement to service connection for diabetes mellitus, type II, with peripheral neuropathy is remanded. 2. Entitlement to service connection for hypertension is remanded. 3. Entitlement to service connection for CAD, to include as secondary to hypertension, is remanded. Remand is necessary to obtain an addendum VA opinion, or a new VA examination if necessary. When VA undertakes to obtain an opinion, it must ensure that the opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion is considered adequate "where it is based on consideration of the veteran's prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one." Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Here, the December 2017 VA examiner did not address whether the Veteran's service-connected disabilities caused or aggravated the Veteran's obesity as an intermediate step between the service-connected disability and his diabetes mellitus, hypertension, and CAD on a secondary basis. The examiner did report medical literature providing a link between obesity and hypertension and also stated that obesity is a substantial risk factor for heart disease, but the examiner did not offer an opinion as to whether his service-connected disabilities led to his obesity. Therefore, remand a required to obtain an addendum VA opinion, or to provide an additional VA examination if found necessary. The matters are REMANDED for the following action: 1. Obtain an addendum VA opinion, or a new VA examination if necessary, by an appropriate clinician to opine whether the Veteran's obesity is an intermediate step between his service-connected disabilities and diabetes mellitus, type II, with peripheral neuropathy. Specifically, the examiner must opine as to whether it is at least as likely as not that: The Veteran's service-connected disabilities, to include prescribed medication for their treatment, caused him to become obese; Such obesity was substantial factor in causing his diabetes; and His current diabetes mellitus would not have occurred but for obesity caused by the service-connected disabilities. 2. Obtain an addendum VA opinion, or a new VA examination if necessary, by an appropriate clinician to opine whether the Veteran's obesity is an intermediate step between his service-connected disabilities and hypertension. Specifically, the examiner must opine as to whether it is at least as likely as not that: The Veteran's service-connected disabilities, to include prescribed medication for their treatment, caused him to become obese; Such obesity was substantial factor in causing his hypertension; and His current hypertension would not have occurred but for obesity caused by the service-connected disabilities. 3. Obtain an addendum VA opinion, or a new VA examination if necessary, by an appropriate clinician to opine whether the Veteran's obesity is an intermediate step between his service-connected disabilities and CAD or whether his CAD is secondary to hypertension. Specifically, the examiner must opine as to whether it is at least as likely as not that: The Veteran's service-connected disabilities, to include prescribed medication for their treatment, caused the Veteran to become obese; Such obesity was substantial factor in causing his CAD; and His current CAD would not have occurred but for obesity caused by the service-connected disabilities. The examiner must also provide a well-reasoned opinion as to whether it is at least as likely as not that: The Veteran's CAD was caused by hypertension, or The Veteran's CAD was aggravated beyond its natural progression by hypertension. The Board notes that the Veteran is service-connected for major depressive disorder, headaches, a left scapula disorder, lumbar and spine disorders, radiculopathy of the bilateral lower extremities, voiding dysfunction, hemorrhoids, and left arm numbness. Each examiner must specifically consider all relevant lay and medical evidence of record and must explain the reasons behind any opinions and conclusions reached. 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 or record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor or the proposition as it is to find against it. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Thompson, Associate 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.