Citation Nr: 22019840 Decision Date: 04/03/22 Archive Date: 04/03/22 DOCKET NO. 09-03 359A DATE: April 3, 2022 REMANDED Entitlement to service connection for prostate cancer, to include as secondary to service-connected low back disability and/or right ankle disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1971 to November 1973. This appeal to the Board of Veterans' Appeals (Board) is from an October 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), which is the Agency of Original Jurisdiction (AOJ). In June 2021, the Board remanded this claim back to the RO (AOJ) for further development and consideration including for a VA medical opinion concerning whether the Veteran's service-connected low back and right ankle disabilities caused or aggravated his obesity that, in turn, caused or aggravated his prostate cancer. In other words, medical opinion was needed concerning whether his obesity is an "intermediate step". Since there has not been compliance, even the acceptable substantial compliance, with that remand directive, the Board must again remand this claim. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with the remand instructions); but see also D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that only "substantial" rather than strict or exact compliance with the Board's remand directives is required under Stegall); accord Dyment v. West, 13 Vet. App. 141, 146-47 (1999). Another remand is required. Entitlement to service connection for prostate cancer, including as secondary to service-connected low back disability and/or right ankle disability, again is remanded. As already mentioned, this claim is predication on the notion that the Veteran's service-connected low back disability and/or right ankle disability caused or aggravated his obesity, and that his obesity in turn caused or aggravated his prostate cancer. So, he is contending his obesity was an "intermediate step". Obesity may act as an "intermediate step" between a service-connected disability and a current disability for which secondary service connection may be established. See VAOPGCPREC 1-2017 (Jan. 6, 2017); see also Walsh v. Wilkie, 32 Vet. App. 300 (2020), As such, VA must resolve: (1) whether a service-connected disability caused a Veteran to become obese or aggravated his obesity; (2) if so, whether the obesity because of the service-connected disability was a substantial factor in causing or aggravating the claimed disability; and (3) whether the claimed disability would not have occurred but for obesity caused by the service-connected disability. The Board's prior July 2021 remand of this claim resultantly requested a VA medical opinion concerning this notion that obesity was an "intermediate step" in this posited correlation between the service-connected disabilities and eventual development of prostate cancer. In January 2022, to this end, a VA compensation examiner provided an opinion, however, it does not sufficiently address this posited correlation so is inadequate. In this circumstance, the Board must correct this failing by obtaining all needed additional information. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that, when VA endeavors to provide an examination for an opinion, it must ensure the examination and opinion are adequate). More specifically, the January 2022 VA examiner provided an opinion that the Veteran's prostate cancer was not caused or aggravated by any service-connected disability. But the examiner did not discuss obesity as an intermediate step. Thus, there has not been acceptable substantial compliance with this remand directive, meaning another remand of this claim is required because this compliance is mandatory not, instead, discretionary. See Stegall, 11 Vet. App. at 271. Accordingly, this claim is again REMANDED for the following still additional development and consideration: Obtain an addendum to the January 2022 VA examiner's opinion concerning the origins of the Veteran's prostate cancer in relation to his service-connected low back and right ankle disabilities: A) More specifically, did his service-connected low back and right ankle disabilities cause OR aggravate his obesity? B) If they did, did the obesity in turn cause OR aggravate his prostate cancer? In other words, was the obesity and "intermediate step"? *When responding, the examiner must be certain to address both causation AND aggravation. Rationale for the responses is essential, regardless of whether favorable or conversely unfavorable to this claim, preferably citing to findings or other evidence in the file supporting conclusions and/or accepted medical authority. KEITH W. ALLEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Pak 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.