Citation Nr: 20045877 Decision Date: 07/09/20 Archive Date: 07/09/20 DOCKET NO. 15-10 206A DATE: July 9, 2020 ORDER Entitlement to service connection for cerebrovascular accident, including ischemic stroke and hypertensive stroke, to include as secondary to hypertension, chronic pain from left shoulder and back disabilities, posttraumatic stress disorder (PTSD), kidney cancer, colon cancer, and heart disease, is denied. FINDING OF FACT 1. A May 2018 rating decision denied the Veteran’s claims for service connection for colon cancer, ischemic heart disease, kidney cancer, and PTSD. The Veteran properly initiated an appeal but did not perfect his appeal following the issuance of a May 2019 statement of the case (SOC), and the May 2018 rating decision is final. 2. A June 2019 Board decision denied the Veteran’s claims for service connection for hypertension, a left shoulder disability, and a thoracic spine disability. The Veteran did not file a timely notice of appeal, and the June 2019 Board decision is final. 3. Cerebrovascular accident, including ischemic stroke and hypertensive stroke, did not have its onset during active service or within one year of service discharge and is not otherwise related to active service. CONCLUSION OF LAW The criteria for service connection for cerebrovascular accident, including ischemic stroke and hypertensive stroke, to include as secondary to hypertension, chronic pain from left shoulder and back disabilities, PTSD, kidney cancer, colon cancer, and heart disease, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1980 to August 1987, with additional service in the Army National Guard of Louisiana. The Veteran testified at a videoconference hearing before the undersigned in November 2017 and a transcript of the hearing has been associated with the claims file. This matter was previously remanded by the Board in January 2018 and June 2019 to allow the Veteran’s intertwined claims of entitlement to service connection for hypertension, chronic pain from left shoulder and back disabilities, PTSD, kidney cancer, colon cancer, and heart disease to be properly developed and adjudicated. As this has now been completed, the Board may proceed with consideration of the instant claim. Entitlement to service connection for cerebrovascular accident, including ischemic stroke and hypertensive stroke, to include as secondary to hypertension, chronic pain from left shoulder and back disabilities, PTSD, kidney cancer, colon cancer, and heart disease. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. For certain chronic disorders, including a brain hemorrhage, which is a type of stroke, service connection may be granted on a presumptive basis if the disease is manifested to a compensable degree within one year following service discharge. Service connection may also be granted on a secondary basis for a current disability which is proximately due to or the result of a service-connected disease or injury. Where a service-connected disability aggravates a nonservice-connected condition, a Veteran may be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. The Veteran claims that his post-service cerebrovascular accident, including ischemic stroke and hypertensive stroke, is a result of various other conditions, including hypertension, but also chronic pain from left shoulder and back disabilities, PTSD, kidney cancer, colon cancer, and heart disease. His March 2014 statement, April 2015 VA Form 9 substantive appeal, and November 2017 hearing testimony all consistently assert his claim on a secondary basis. Following a review of the evidence of record, and as discussed further below, the Board finds that the evidence of record weighs against the Veteran’s claim. As to evidence of a current disability, post-service private treatment records document that the Veteran experienced a stroke in June 2012, and required subsequent treatment for the residuals of that incident. Thus, this first criterion is met. Regarding evidence of an in-service disease or injury, service treatment records do not document that the cerebrovascular accident, including ischemic stroke and hypertensive stroke, had its onset during active service or within one year of his service discharge in August 1987. To reiterate, the stroke occurred in June 2012, which is decades after service discharge and is evidence against it manifesting within one year of service discharge. As such, the in-service element of a direct service connection claim is not met, and service connection is not warranted on a direct or presumptive basis. Additionally, there is no competent and probative evidence of a direct nexus between the Veteran’s June 2012 cerebrovascular accident, including ischemic stroke and hypertensive stroke, and his active service. To the extent that the Veteran has consistently claimed that his ischemic stroke and hypertensive stroke are secondary to hypertension, chronic pain from left shoulder and back disabilities, PTSD, kidney cancer, colon cancer, and heart disease, the record documents that a May 2018 rating decision denied the Veteran’s claims of entitlement to service connection for colon cancer, ischemic heart disease, kidney cancer, and PTSD. Although the Veteran properly initiated an appeal of this denial, he did not perfect his appeal following the issuance of a May 2019 statement of the case (SOC), and the May 2018 rating decision became final. Similarly, a June 2019 Board decision denied the Veteran’s claims of entitlement to service connection for hypertension, a left shoulder disability, and a thoracic spine disability, after which he did not file a timely notice of appeal, and the June 2019 Board decision became final. Given the above, the Veteran is not service connected for hypertension, chronic pain from left shoulder and back disabilities, PTSD, kidney cancer, colon cancer, and heart disease. As such, his claim of entitlement to service connection for ischemic stroke and hypertensive stroke is not warranted on a secondary basis as a matter of law. 38 C.F.R. § 3.310. The Veteran was not afforded a VA examination in connection with the claim for service connection for cerebrovascular accident. The Board finds that the facts of this case do not establish entitlement to a VA examination or medical opinion. For example, VA must provide a medical examination or opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this case, the Board finds that the record does not show evidence establishing that an event, injury, or disease related to a stroke occurred in service nor is there an indication that the stroke may be associated with the Veteran’s service or a service-connected disability. For a VA examination to be warranted, all the criteria have to be met, and at least one of the criteria is not met. Therefore, entitlement to a VA examination and/or medical opinion is not warranted for the claim for service connection for cerebrovascular accident, including ischemic stroke and hypertensive stroke. In conclusion, the Board finds that the preponderance of the evidence weighs against the Veteran’s claim of entitlement to service connection for cerebrovascular accident, including ischemic stroke and hypertensive stroke. As such, there is no reasonable doubt to be resolved, and the claim is denied. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Chad Johnson, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.