Citation Nr: 22018398 Decision Date: 03/29/22 Archive Date: 03/29/22 DOCKET NO. 13-33 249 DATE: March 29, 2022 REMANDED Entitlement to dependency and indemnity compensation (DIC) for service connection for the cause of the Veteran's death is remanded. Entitlement to service connection for circulation problems in the bilateral legs is remanded. Entitlement to service connection for strokes is remanded. REASONS FOR REMAND Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran's claim so that he is afforded every possible consideration. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. The Veteran had active military service from September 1948 to May 1952. This matter comes before the Board of Veterans' Appeals (Board) from the rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared at a January 2017 hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. Sadly, the Veteran passed away in May 2011. The Veteran's surviving spouse has been substituted in as the Appellant. This matter was previously before the Board in October 2021 and was remanded for further development in conjunction with an August 2021 Joint Motion for Partial Remand by the United States Court of Appeals for Veterans Claims. 1. Entitlement to service connection for the Veteran's cause of death is remanded. 2. Entitlement to service connection for circulation problems in the bilateral legs is remanded. 3. Entitlement to service connection for strokes is remanded. As noted above, this matter was previously before the Board in October 2021 and was remanded for an addendum opinion. Specifically, the Board directed the Agency of Original Jurisdiction (AOJ) to obtain an addendum opinion addressing whether the Veteran's service-connected disabilities caused or aggravated his obesity and, if so, whether the Veteran's obesity, as a result of his service-connected disabilities, was a substantial factor in causing the claimed circulation problems in the legs and strokes, or the cause of the Veteran's death. Subsequently, an addendum opinion was obtained in December 2021. The examiner opined that it is at least as likely as not that the Veteran's service connected disabilities contributed to him becoming overweight/obese and aggravated his obesity beyond its natural progression. However, the examiner did not discuss whether the Veteran's obesity, as a result of or aggravated by his service-connected disabilities, was a substantial factor in causing or aggravating the Veteran's circulation problems in the legs, the Veteran's strokes, and/or the cerebrovascular disease and atherosclerotic vascular disease listed as the causes of his death on the Veteran's death certificate. Additionally, the examiner did not answer the October 2021 Board remand's directive as to whether the Veteran's strokes, and the cerebrovascular disease and atherosclerotic vascular disease listed as the causes of his death on the Veteran's death certificate, would have not occurred but for the obesity caused by or aggravated by the Veteran's service-connected disabilities. As a matter of law, a remand by the Board confers upon the Veteran the right to compliance with the Board's remand order. Stegall v. West, 11 Vet. App. 268, 270-71 (1998). As such, in accordance with Stegall, remand for full compliance with the Board's prior remand is warranted. The matters are REMANDED for the following action: 1. Obtain an addendum opinion by the December 2021 examiner, or another qualified clinician, to answer the following: a) Was the Veteran's obesity a substantial factor in causing or aggravating the Veteran's circulation problems in the legs, the Veteran's strokes, and/or the cerebrovascular disease and atherosclerotic vascular disease listed as the causes of his death on the Veteran's death certificate? b) Would the Veteran's circulation problems in the legs, the Veteran's strokes, and the cerebrovascular disease and atherosclerotic vascular disease listed as the causes of his death on the Veteran's death certificate have not occurred but for the Veteran's obesity caused by or aggravated by his service-connected disabilities? The Veteran's obesity is already considered proximity due to and aggravated by the Veteran's service-connected disabilities. Aggravation is defined as a worsening beyond the natural progression of the disease. The examiner must note that an opinion to the effect that one disability "is not caused by or a result of" another disability does not answer the question of aggravation and will necessitate a further opinion. See El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013). The examiner must review the record and consider the relevant evidence of record, to include the records describing the Veteran's medical history and treatment, functional abilities, exercise habits, and dietary habits. Specifically, the examiner should note the records showing that in September1997the Veteran reported to a VA examiner that, although he had minor cold sensitivity during the winter, his feet were not bothersome and that he was able to exercise by walking up to 3miles per day. In May 2002, he admitted to his medical treatment provider that prior to the winter of 2000 and 2001 he would exercise by walking 2 and a half miles per day but that he stopped walking during the winter and did not resume due to fatigue. In April 2002, he admitted to not following any specific meal plan and to overeating while in Florida. In April 2003, he reported that he had received no regular exercise while wintering in Florida, but that he had resumed exercising by walking three times per week for 1 and 3/10 of a mile. In June 2004, the Veteran reported to a VA examiner that he had been able to walk 3 miles with no difficulty or increased symptoms in his feet until he had his stroke in late 2003. All opinions provided must be thoroughly explained and an adequate rationale for any conclusions reached must be provided. The examiner should not rely on the absence of evidence of in-service treatment or injury in the Veteran's service treatment records as a basis for any given opinion. If any requested opinion cannot be provided without resort to speculation, the medical professional should state and explain why an opinion cannot be provided without resort to speculation. 2. Following completion of the above, and a review of any additional evidence received, the RO should also undertake any other development it deems to be necessary, to include, if warranted, an addendum medical opinion which considers any newly received evidence. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Mountford, 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.