Citation Nr: 18151281 Decision Date: 11/16/18 Archive Date: 11/16/18 DOCKET NO. 13-16 178 DATE: November 16, 2018 REMANDED Entitlement to service connection for a stroke is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1969 to June 1971. This case is before the Board of Veterans’ Appeals (Board) on appeal from a January 2013 Regional Office (RO) rating decision. In that rating decision, the RO denied entitlement to service connection for ischemic heart disease and stroke. In June 2016, the Board remanded the case to the RO for further development and adjudicative action. The RO granted service connection for ischemic heart disease and assigned a noncompensable rating, effective October 31, 2013, in a December 2016 rating decision. This is a full grant of the benefit sought on appeal with respect to the issue of entitlement to service connection for ischemic heart disease and therefore, this issue is no longer before the Board. The Veteran appealed the initial rating assigned by the RO in a January 2017 notice of disagreement. However, in a May 2018 rating decision, the RO severed service connection for ischemic heart disease, effective August 31, 2018 due clear and unmistakable error in the grant of service connection for ischemic heart disease. A June 2018 statement of the case recharacterized the Veteran’s appeal for an initial rating as continued entitlement to compensation for ischemic heart disease. The Veteran did not perfect his appeal with respect to the initial rating claim by submitting a VA Form 9 in response to the June 2018 statement of the case. Although the Veteran’s representative addressed the issue of entitlement to continued entitlement to compensation for ischemic heart disease in the October 2018 Written Brief Presentation, that issue is not ripe for appellate review at this time because the Veteran has not yet perfected his appeal with respect to the June 2018 statement of the case. Furthermore, he has not, at this time, submitted a notice of disagreement with the May 2018 rating decision. The Board notes that the Veteran has one year from the date of the notification letter of the rating decision to submit a notice of disagreement. Therefore, the Board does not have jurisdiction to address the issue of entitlement to restoration of service connection for ischemic heart disease at this time. 1. Entitlement to service connection for a stroke is remanded. Thr Board remanded the service connection claim for stroke in June 2016 in part to obtain a VA medical opinion that adequately addresses whether the 2012 stroke and any residuals thereof are caused by or related to active military service to include his presumed exposure to herbicides. The Veteran was provided with a VA medical opinion in January 2017. A VA physician provided the medical opinion that the 2012 stroke was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The physician explained that a review of his service treatment records and medical literature does not reveal any in-service event, including presumed exposure to herbicides, that could have directly caused a stroke 41 years later. However, the Board notes that the National Academies of Sciences, Engineering and Medicine “Veteran’s and Agent Orange: Update 2012” and the National Academies of Sciences, Engineering and Medicine titled, “Veterans and Agent Orange: Update 2014” reveals that the Committee concluded that Agent Orange was a limited or suggestive risk factor for stroke. The physician did not address the Committee’s conclusions or discuss in any detail the medical literature he relied upon to reach his negative medical opinion. Accordingly, the Board finds that another remand is necessary to obtain an adequate medical opinion with respect to the issue of whether the July 2012 stroke was caused by or related to the Veteran’s presumed exposure of herbicides during active military service. The matters are REMANDED for the following action: Obtain a medical opinion regarding the Veteran’s service connection claim for a stroke and any residuals thereof from an appropriate medical specialist. Only arrange for the Veteran to undergo an examination if one is deemed necessary in the judgment of the medical specialist designated to provide the medical opinion. The electronic claims file and a copy of this remand must be made available to the medical specialist for review and the report should reflect that the claims file was reviewed in connection with the opinion. The medical specialist is requested to review all pertinent records associated with the claims file and offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s July 2012 stroke is caused by or related to his presumed exposure to herbicides during active military service. The medical specialist is reminded that the fact that stroke or any residuals thereof are not recognized as a presumptive disability resulting from herbicide exposure, does not, alone, support an opinion that a veteran’s exposure to herbicide agents did not result in that condition. See Polovick v. Shinseki, 23 Vet. App. 48, 55 (2009). Any opinion offered should be accompanied by the underlying reason for the conclusion. A discussion of the facts and the medical principles involved is required. It would be helpful if the medical specialist could reference and discuss specific studies and/or medical articles as part of his or her opinion with respect to whether the Veteran’s stroke is related to herbicide exposure during service. In this regard, the medical specialist is asked to specifically discuss the National Academies of Sciences, Engineering and Medicine “Veteran’s and Agent Orange: Update 2012” and the National Academies of Sciences, Engineering and Medicine titled, “Veterans and Agent Orange: Update 2014” where the Committee concluded that Agent Orange was a limited or suggestive risk factor for stroke. L. B. CRYAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Berry, Counsel