Factual and Procedural History
The Veteran served in the United States Air Force from November 1984 to December 2004. While in service, he was diagnosed with tuberculosis and treated with an antibiotic called isoniazid. Shortly after beginning treatment, elevated liver enzymes were noted and his use of the antibiotic was discontinued. In November of 2002, the Veteran was diagnosed with hepatic steatosis. Two years later, he filed an initial claim for service connection for hepatic steatosis, asserting that his treatment with isoniazid caused it. However, his claim was quickly denied by the Regional Office. The Veteran continued to appeal to the Board of Veterans’ Appeals, where his case was remanded in 2011 and again in 2014. Throughout this appeals process, he established service connection for a back condition, knee condition, and respiratory disabilities. He also began gaining weight and was eventually diagnosed with morbid obesity. Medical records attributed the Veteran’s weight gain to a variety of factors, including difficulty exercising because of his back and knee pain. In February of 2016, the Veteran attended a VA examination in which the examiner found that his hepatic steatosis was not the result of his treatment with isoniazid. However, the examiner did attribute the condition to his obesity. Nonetheless, the Board denied service connection.
Board Denies Service Connection for Hepatic Steatosis
In February of 2017, the Board issued a decision denying the Veteran’s claim for service connection for hepatic steatosis. In its decision, the Board relied on the February 2016 VA examination that determined the Veteran’s condition was not due to the isoniazid as he originally contended. Furthermore, the Board decision did not address whether the Veteran’s obesity could have been due to his service-connected conditions and thereby used as an intermediate step in awarding secondary service connection for hepatic steatosis.
CCK Argues Secondary Service Connection Should Be Addressed
CCK successfully appealed to the Court of Appeals for Veterans Claims (CAVC) the Board decision that denied service connection for hepatic steatosis. CCK argued that the February 2016 examination report raised the issue of whether the Veteran’s hepatic steatosis is secondary to his service-connected back, knee, and respiratory disabilities, since they prevented him from exercising and contributed to the development of obesity. CCK cited a precedential opinion to demonstrate that obesity can be an intermediate step between a current disability and a service-connected disability if the Board finds that (1) the service-connected disability caused the Veteran to become obese; (2) obesity was a substantial factor in causing the claimed secondary disability; and (3) the claimed secondary disability would not have occurred but for the obesity caused by the service-connected disability.
CAVC Agrees: Board Failed to Address Obesity as Intermediary
CCK successfully argued, and the Court agreed, that the issue of entitlement to service connection for the Veteran’s hepatic steatosis as secondary to his service-connected disabilities, with obesity as intermediary, was raised by the record and that the Board erred in failing to address it. The Court noted the Veteran cited several documents of record demonstrating the fact that his service-connected back and knee disabilities resulted in weight gain and that these conditions severely impair or prevent his ability to exercise. Ultimately, the Board should have taken such information into consideration when rendering its decision. Accordingly, the Court vacated and remanded the case back to the Board for additional development and readjudication.