Citation Nr: 18145199 Decision Date: 10/26/18 Archive Date: 10/26/18 DOCKET NO. 16-16 204 DATE: October 26, 2018 ORDER Service connection for a stroke (and related residuals) as secondary to service-connected diabetes mellitus and ischemic heart disease (IHD) is granted. FINDING OF FACT The weight of the evidence is in favor of finding that the Veteran had a stroke that was proximately related to his service-connected diabetes mellitus and IHD. CONCLUSION OF LAW The criteria for entitlement to service connection for a stroke, secondary to service-connected diabetes mellitus and IHD, have been met. 38 U.S.C. §§ 1110, 5107, 7104(d); 38 C.F.R. §§ 3.102, 3.159(a)(1), 3.310(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the Air Force from October 1968 to August 1972. This matter comes before the Board on appeal from a May 2015 rating decision. The Veteran submitted a notice of disagreement in June 2015. The RO issued a statement of the case in June 2015. The Veteran submitted an appeal to the Board in April 2016. The RO issued a supplemental statement of the case in September 2016. The appeal was certified in September 2016. Service connection for a stroke as secondary to diabetes mellitus and IHD is granted. The Veteran is seeking service connection for a stroke, which he contends is secondary to his service connected diabetes mellitus type II. Regulations provide that service connection is warranted for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Further, a disability which is aggravated by a service-connected disorder may be service connected to the degree that the aggravation is shown. Allen v. Brown, 7 Vet. App. 439, 449 (1995); 38 C.F.R. § 3.310(b). In order to establish entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; (3) medical evidence establishing a nexus between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). To comply with 38 U.S.C. § 7104(d), the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the veteran. Eddy v. Brown, 9 Vet. App. 52, 58 (1996). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, then the issue will be resolved in favor of the Veteran. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The evidence as to whether the Veteran had a stroke is somewhat mixed. The Veteran states that he had a stroke in March 2015. The Veteran submitted July 2015 and September 2016 letters from Dr. D.T., who concluded that the Veteran did have a stroke. The Veteran’s medical records subsequent to March 2015 reflect that the Veteran had a history of a stroke, and that the Veteran had a couple minor residual effects from this stroke, such as dizziness and paresthesia. However, Dr. M.H. examined the Veteran in May 2016 after reviewing his medical records and concluded that there was insufficient evidence of a stroke. Dr. H. came to this conclusion because a CT scan and MRI performed at the time of the supposed stroke came back normal, when a stroke victim would be expected to have an abnormal lesion that would be detected via these methods. Both Dr. D.T. and Dr. H. are qualified to offer competent medical diagnoses, statements, or opinions because they have specialized education, training, and experience. 38 C.F.R. § 3.159(a)(1). Because both doctors are competent to offer medical opinions, their testimony may be heard and considered by the Board. The Board must also consider the credibility of Dr. D.T. and Dr. H.; credibility is a factual determination going to the probative value of the evidence once the evidence has already been admitted. Layno v. Brown, 6 Vet. App. 465, 469 (1994). Dr. D.T.’s report was credible because she is an attending physician who has seen the Veteran many times and thus is very familiar with the Veteran’s medical history and health problems. Her analysis was based on her experience treating the Veteran and a review of the Veteran’s medical record, and thus her conclusion that the Veteran had a stroke is credible. Dr. H.’s report was also credible because her analysis was based on examining the Veteran and reviewing his medical file. Further, Dr. H. supported her conclusions by explaining why she thought that the result of medical testing the Veteran underwent was inconsistent with a diagnosis of a stroke. However, Dr. D.T.’s report should be afforded slightly more weight than Dr. H.’s because it is more consistent with the entirety of the Veteran’s medical history and treatment as documented in the claims file. Dr. H. is the doctor who saw the Veteran who concluded that the Veteran did not in fact have a stroke. Because more weight should be afforded to Dr. D.T., the Board finds that it is more likely than not that the Veteran did suffer from a stroke. The Board finds that the competent and credible evidence is at least in equipoise as to whether the Veteran had a stroke and has current residuals. As such, the first element of secondary service connection has been established. The evidence as to whether the Veteran’s stroke was proximately due to or the result of a service connected disability is also mixed. A September 2015 rating decision granted service connection for diabetes mellitus type II and ischemic heart disease (coronary artery disease). The Veteran was also service connected for hypertension in April 2016. The Veteran submitted July 2015 and September 2016 letters from Dr. D.T., who concluded that the Veteran’s stroke was directly related to his diabetes mellitus and his coronary artery disease. Dr. D.T. did not provide any analysis or rationale for her conclusion that the stroke was directly related to the Veteran’s diabetes mellitus and coronary artery disease. However, Dr. H.’s analysis suggests the contrary: in her opinion the stroke that the Veteran suffered was not the same type of stroke as would be caused by diabetes or hypertension. According to Dr. H., a stroke caused by diabetes mellitus would be an infarct type stroke. Strokes caused by hypertension are infarct or hemorrhagic type strokes. Infarct or hemorrhagic type strokes both would show on a CT scan and MRI, and in the Veteran’s case his CT and MRI were normal. Thus, Dr. H. concludes that even if the Veteran had a stroke, it was less likely than not related to his diabetes mellitus or hypertension. However, Dr. H.’s report only addressed diabetes mellitus and hypertension and the possible link between those two conditions and the claimed stroke; Dr. H. did not address whether or not the Veteran’s coronary artery disease could have led to his stroke. (Continued on the next page)   In all, the Board finds that the evidence is in relative equipoise regarding whether his stroke was caused by his service connected diabetes mellitus and/or coronary artery disease. Since the Board must resolve reasonable doubt in the Veteran’s favor on this material issue, the Board finds the nexus element has been established. Therefore, the Veteran’s stroke was the proximate result of a service-connected disability, and thus he is entitled to secondary service connection for his stroke. Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Macchiaroli, Law Clerk