Citation Nr: 19128751 Decision Date: 04/12/19 Archive Date: 04/12/19 DOCKET NO. 18-05 966 DATE: April 12, 2019 REMANDED Entitlement to service connection for a stroke and all related residuals, to include as due to exposure to environmental hazards in Southwest Asia, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1983 to June 1991 and from February 2009 to February 2010, including service in Iraq. A remand is necessary to provide the Veteran with an adequate VA examination to determine the nature and etiology of his currently diagnosed stroke and related residuals. The Veteran underwent a VA Gulf War general medical examination in June 2017, at which time the VA examiner confirmed a diagnosis of a stroke and concluded that because the Veteran’s stroke has a clear and specific etiology with a clear diagnosis, it is less likely than not that the stroke is related to “a specific exposure event in Southwest Asia.” See VA examination report dated June 20, 2017 at pg. 9. However, the opinion does not discuss the specific exposure claimed by the Veteran to have caused his stroke: Smoke from burn pits in Iraq. Indeed, the Veteran asserts that while he was deployed to Iraq he was exposed daily to smoke and particulate matter from burn pits used for disposal of waste, including industrial and human waste. See Letter from the Veteran’s representative dated April 19, 2018. Additionally, the VA examiner offered no etiology opinion in regard to whether the Veteran’s stroke is otherwise directly related to service. Once VA undertakes the effort to provide an examination and medical opinion when developing a claim, even if not statutorily obligated to do so, VA must ensure that the examination, and the medical opinion, are adequate. See Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). Moreover, although the Veteran seeks service connection for a stroke on the basis of his exposure to burn pits in Iraq, he is not precluded from establishing service connection through other proof of direct causation. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Accordingly, a remand to obtain an addendum VA medical opinion is necessary to ensure that the Board’s evaluation of the Veteran’s service connection claim is a fully informed one. The matter is REMANDED for the following action: 1. Ensure that all outstanding VA treatment records are associated with the claims file. 2. Thereafter, obtain an addendum medical opinion regarding the nature and etiology of the Veteran’s currently diagnosed cerebral stroke. The claims file and a copy of this Remand must be made available to the reviewing examiner, and the examiner shall indicate in the addendum report that the claims file was reviewed. *The need for another examination is left to the discretion of the medical professional offering the addendum opinion.   After a complete review of the claims file, the examiner is asked to respond to the following: (a) Provide an opinion whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s cerebral stroke and residuals thereof are a result of his military service, to include exposure to smoke and particulate matter from burn pits while deployed to Iraq. *In providing rationale, the VA examiner must consider the competent and credible lay assertions of the Veteran as expressed by his representative (see VBMS 04/19/2018 “Correspondence”) and the Veteran’s MOS as an engineer and fuel handler stationed at the Forward Operating Base Mahmudiyah and with regular travel to Camp Falcon and Camp Striker. A complete rationale for any opinion expressed should be included in the examination report. 3. Thereafter, readjudicate the remanded claim. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Brad Farrell, Associate Counsel