Veterans are often told flatly that VA does not rate obesity, and they stop there. That misses the actual rule: obesity itself carries no diagnostic code, but under VA General Counsel Opinion 1-2017 and Walsh v. Wilkie it can serve as the intermediate step that connects a service connected condition to diabetes, sleep apnea, or arthritis of the weight bearing joints. The claim lives or dies on a three link chain, and every link needs a medical opinion.
Rule overview
VA does not rate obesity on its own. There is no diagnostic code for it, and weight management is not a compensable disability. But stop there and you miss the actual rule.
Under VA General Counsel Precedent Opinion 1-2017 and the Court of Appeals for Veterans Claims decision in Walsh v. Wilkie (Sept 2018), obesity can serve as an intermediate step in a causal chain that connects a service connected condition to a later, non-service-connected condition. When that chain holds up, the later condition can be granted service connection on a secondary basis.
The three-step test
To win service connection through obesity as an intermediate step, you have to show all three of the following:
- The service connected condition caused the obesity. Example: a service connected back disability made consistent exercise impossible.
- The obesity was a substantial factor in causing the new condition. Example: the obesity contributed to the onset of type 2 diabetes, sleep apnea, hypertension, or knee osteoarthritis.
- The new condition would not have occurred but for the obesity. The obesity has to be necessary, not just one of several contributing factors.
Each link needs a competent medical opinion. Your own statement is not enough on its own.
What the medical opinion needs to say
A favorable opinion for an obesity-as-intermediary claim typically addresses:
- The specific service connected disability and how it caused weight gain, whether through limited mobility, medications with weight-gain side effects, or mental health conditions that affected diet and activity.
- A clear date or time period when obesity became the working diagnosis (BMI at or above 30).
- The mechanism by which obesity contributed to the new condition.
- Why the new condition is unlikely to have developed without the obesity (the "but-for" piece).
- Other risk factors the examiner considered and ruled out, such as genetics, diet, and smoking.
Conditions where obesity is most often the intermediate step
- Type 2 diabetes mellitus, especially when the service connected condition limits exercise
- Obstructive sleep apnea
- Hypertension and downstream cardiovascular disease
- Osteoarthritis of weight-bearing joints, including knees, hips, and the lumbar spine
- GERD
- Coronary artery disease as a long-tail consequence
What does not work
- A claim that says "I gained weight after I got out and now I have diabetes." Without a service connected condition in the chain, obesity creates no path to service connection.
- A claim where medical evidence shows the new condition was caused by something else, such as family history or a diet pattern that predated the service connected condition. That breaks the "but-for" element.
- A claim for obesity itself as a stand-alone rating. VA's rating schedule has no diagnostic code for it.
Applying this to your claim
If you think this path applies to you, work through it in order:
- Identify the service connected condition that caused or substantially worsened your weight gain.
- Identify the secondary condition you want to claim.
- Ask your treating provider or a VA accredited representative whether a nexus opinion covering all three steps is supportable. If they cannot honestly support all three, the claim is not ready.
- File as a secondary service connection claim under 38 CFR 3.310. In the supporting statement, explicitly identify obesity as the intermediate step and cite General Counsel Precedent Opinion 1-2017 and Walsh v. Wilkie.
Where this comes from
- VA General Counsel Precedent Opinion 1-2017 (Jan 6, 2017)
- Walsh v. Wilkie, 30 Vet. App. 322 (2018)
- 38 CFR 3.310 (Disabilities that are proximately due to, or aggravated by, service connected disease or injury)