Citation Nr: 21042194 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 17-09 081 DATE: July 12, 2021 REMANDED The issue of service connection for obstructive sleep apnea (OSA) is remanded. The issue of service connection for hypertension is remanded. The issue of an earlier effective date for the award of a total disability rating based on unemployability (TDIU) is remanded. The issue of an earlier effective date for the award of Dependents' Educational Assistance (DEA) benefits is remanded. REASONS FOR REMAND The Veteran had active service from August 1966 to August 1968. The Board of Veterans' Appeals (Board) has determined additional development is necessary and will remand the matters for the following actions: 1. BACKGROUND FOR THE RO ADJUDICATOR: This is a remand under Stegall v. West, 11 Vet. App. 268 (1998) (holding that a remand by the Court or the Board confers on the veteran or other claimant, as a matter of law, the right to compliance with the remand orders). In February 2021, the Board remanded the issues of service connection for OSA and hypertension and directed the VA Regional Office (RO) to obtain a medical opinion addressing: (1) the cause of the Veteran's OSA and hypertension; and (2) whether the Veteran's service-connected disabilities caused or aggravated his obesity; and (3) whether obesity The opinion obtained in April 2021 did not fully respond to the Board's remand instructions. The examiner concluded PTSD did not cause or aggravate the Veteran's obesity, but did not discuss whether the Veteran's other service-connected disabilities caused or aggravated his obesity. Remand is necessary for an addendum opinion. The issues of earlier effective dates for TDIU and DEA benefits are also remanded because they are intertwined with the remanded service connection issues. 2. REMAND DIRECTIVES: Return the file to the April 2021 VA examiner and request that she respond to the questions below. If she is unavailable, obtain an opinion from a qualified VA PHYSICIAN. The examiner must give a thorough explanation for their opinions. The examiner must answer these questions: (1) Did the Veteran's service-connected diabetes mellitus type II (DM) or diabetes medication cause him to become obese? (2) Did the Veteran's service-connected coronary artery disease (CAD) or CAD medication cause him to become obese? (3) Did the Veteran's DM aggravate (worsen) his obesity? (4) Did the Veteran's CAD aggravate (worsen) his obesity? If aggravation is found, the examiner must establish the baseline level of severity of the Veteran's obesity before aggravation occurred. If the examiner is unable to establish a baseline, they must explain why. (5) Was obesity (or its worsening by a service-connected disability) a substantial factor in causing the Veteran's OSA or hypertension? (6) Would the Veteran's OSA or hypertension not have occurred or worsened but for the weight gain/obesity caused or worsened by his service-connected disabilities? While the examiner must review the entire claim file, her attention is drawn to the following: *March and May 2021 submissions by the Veteran, including web-based articles suggesting a possible link between diabetes, Agent Orange exposure, cardiovascular disease and obesity. See "Third Party Correspondence," received March 1, 2021 and May 14, 2021. *April 2021 VA opinion, which noted the Veteran's obesity is a "multifactorial problem," but also noted diabetes and insulin resistance may be associated with a sedentary lifestyle, which is also a risk factor for obesity. See "C&P Exam," received April 21, 2021. If the RO continues to deny the claims, it should issue a Supplemental Statement of the Case (SSOC) and give the Veteran and his representative a reasonable opportunity to respond to the SSOC before returning the appeal to the Board. The Veteran has the right to submit additional evidence and argument on the matter or matters the Board remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). Vito A. Clementi Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Hiaasen The Board's decision is only binding on this case. This action is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.