Citation Nr: 25002015 Decision Date: 02/11/25 Archive Date: 02/11/25 DOCKET NO. 20-16 602 DATE: February 11, 2025 REMANDED Entitlement to service connection for deep vein thrombosis, to include as secondary to service-connected adjustment disorder is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1986 to July 1994 and from December 2003 to October 2004. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a December 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the appeal in December 2023 and denied the claims in an April 2024 decision. The appellant timely appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In October 2024, the Court granted a Joint Motion for Remand (JMR), which vacated the April 2024 decision and remanded the matter for readjudication and further development consistent with the terms of the JMR. 1. Entitlement to service connection for deep vein thrombosis, to include as secondary to service-connected adjustment disorder, is remanded. The parties to the JMR agreed that the Board erred when it relied on an inadequate March 2024 VA medical opinion to adjudicate the Veteran's deep vein thrombosis claim. Specifically, the parties agreed that the March 2024 VA medical opinion is inadequate because the examiner did not provide a sufficient rationale. In his opinion, the examiner noted that the Veteran has a history of several risk factors aside from his service-connected adjustment disorder, and therefore it is less likely than not that his adjustment disorder is the cause of his obesity. The JMR noted that this is not the correct standard to assess whether the service-connected condition caused the Veteran to become obese. The fact that obesity may be caused or aggravated by other factors does not mean that his adjustment disorder cannot also play a role in the Veteran becoming obese. See Walsh v. Wilkie, 32 Vet. App. 300, 307 (2020). The parties to the JMR therefore stipulated that remand was required to obtain a new adequate medical opinion that determines whether the Veteran's service-connected adjustment disorder resulted in or aggravated his obesity, and if so, whether such obesity was a substantial factor in causing his DVT. 2. Entitlement to a TDIU is remanded. The parties to the JMR also agreed that the Veteran's claim for entitlement to TDIU is inextricably intertwined with his claim for DVT. Therefore, the claim should be remanded as inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion from a qualified VA clinician addressing the nature and etiology of the Veteran's DVT. An in-person examination need not be scheduled unless deemed necessary by the examiner or otherwise required by the evidence. The examiner should review the claims file and the Board's remand. VA has recognized that obesity may qualify as an "intermediate step" between a service-connected disability and a current disability. Thus, the examiner should provide a fully articulated medical opinion addressing the following: A) Is it at least as likely as not that the Veteran's service-connected adjustment disorder caused him to become obese? B) If so, is it at least as likely as not that the obesity was a substantial factor in causing the DVT? C) If yes, then is it at least as likely as not that the DVT would not have occurred but for the obesity? The examiner should also consider and discuss aggravation. D) Is it at least as likely as not that the Veteran's service-connected adjustment disorder aggravated his obesity? E) If so, is it at least as likely as not that the obesity was a substantial factor in causing the DVT? F) If yes, then is it at least as likely as not that the DVT would not have occurred but for the obesity? The examiner is to provide separate opinions addressing causation and aggravation. That is, address A) - F). Provide a complete rationale for the opinions offered. If an opinion cannot be reached without resorting to speculation, the examiner must fully explain why that is so. 2. Thereafter, readjudicate the issues on appeal, including entitlement to TDIU. D. JOHNSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mazzucchelli, Michael G. 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.