Millard W. Adams v. Douglas A. Collins, 23-5064

In 2017, the VA General Counsel issued a precedent opinion (G.C. Prec. 1-2017) stating obesity cannot be service connected as a disability or disease under 38 U.S.C. § 1110 or 38 C.F.R. § 3.310.
Millard W. Adams, a veteran with service-connected PTSD, sought service connection for obesity as secondary to his PTSD, but the Board denied his claim in May 2023 based on the G.C. opinion.
Adams appealed to the Court of Appeals for Veterans Claims, challenging the validity of the G.C. opinion under recent Federal Circuit precedent, particularly Saunders v. Wilkie.
The case concerns both direct service connection (incurred in service) and secondary service connection (obesity as a result of another service-connected disability).
The Board also dismissed higher rating/effective date claims for diabetes-related neuropathy (not challenged here) and remanded a sleep apnea claim (not before this Court).
A dissenting judge argued the Board's decision and the G.C. opinion ignored binding appellate law and recent medical consensus recognizing obesity as a disease.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Is obesity categorically excluded as a "disability" under §1110?	Obesity can be a disability if it functionally impairs earning capacity.	G.C. opinion is valid; VA can exclude obesity because most obese people aren't impaired.	G.C.'s exclusion is not persuasive; obesity can be a disability if it impairs earning capacity.
Is obesity categorically excluded as a "disease" under §1110?	Saunders makes the statute unambiguous—"disability" is all that matters.	Secretary has gap-filling authority; no consensus obesity is a disease.	G.C. opinion persuasive for direct service connection—obesity not a "disease" under §1110.
Is obesity excluded from secondary service connection?	"Disease" label irrelevant for secondary claims; focus is on disability and but-for causation.	Obesity must still be a "disease" or "injury" to qualify.	G.C. opinion invalid here; for secondary basis, focus is on functional impairment, not "disease."
Did the Board adequately consider evidence of functional impairment?	Board ignored medical evidence of impairment caused by obesity.	No obligation to address all evidence; no proof obesity causes functional impairment.	Remand required; Board must address whether claimant's obesity impairs earning capacity.

Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (held pain can be a disability if it causes functional impairment, even absent underlying disease)
Allen v. Brown, 7 Vet.App. 439 (1995) (secondary service connection covers any increased disability resulting from a service-connected condition)
Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (clarified statutory basis for secondary service connection and discussed functional impairment)
Larson v. McDonough, 10 F.4th 1325 (Fed. Cir. 2021) (jurisdiction exists to review Board refusal to recognize obesity as a disability, not just rating schedule issues)
Terry v. Principi, 340 F.3d 1378 (Fed. Cir. 2003) (disabilities must be attributable to a disease or injury incurred or aggravated in service)