Citation Nr: 21000241 Decision Date: 01/04/21 Archive Date: 01/04/21 DOCKET NO. 14-34 963 DATE: January 4, 2021 ORDER Entitlement to an extraschedular rating for left ear hearing loss is dismissed. REMANDED Entitlement to service connection for residuals of a stroke is remanded. FINDING OF FACT As the Veteran has been assigned a TDIU for the entire period on appeal, the issue of entitlement to an extraschedular rating for left ear hearing loss is moot. CONCLUSION OF LAW The issue of entitlement to an extraschedular rating for left ear hearing loss is moot. 38 U.S.C. § 1155; 38 C.F.R. § 3.321; Johnson v. McDonald, 762 F.3d 1362 (Fed. Cir. 2014). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran, who is the appellant in this case, served on active duty from February 1963 to February 1967. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The issues on appeal were previously remanded in May 2018 and October 2020. Extraschedular Rating for Left Ear Hearing Loss A review of the record indicates that an April 2020 rating decision granted entitlement to a TDIU, effective September 18, 2012 (throughout the entire rating period on appeal). The Board notes that schedular, extraschedular, and TDIU ratings are various avenues in which higher ratings may be awarded, which has already been achieved in this Veteran’s case. The Federal Circuit’s holding in Johnson v. McDonald, 762 F.3d 1362, 1365-6 (2014) indicate that the grant of a TDIU renders moot the issue of entitlement to an extraschedular rating because the regulatory gap that 38 C.F.R. § 3.321 (b)(1) is designed to fill does not exist when TDIU has been granted. Accordingly, the issue of whether the Veteran’s service-connected left ear hearing loss warrants an extraschedular evaluation pursuant to 38 C.F.R. § 3.321 (b)(1) is moot, as he is now in receipt of a TDIU during the entire period on appeal. Therefore, the issue of entitlement to an increased rating on an extraschedular basis for left ear hearing loss must be dismissed as moot. REASONS FOR REMAND The Veteran had an ischemic stroke in April 2008. See September 2009 VA treatment record. The Veteran contends that this stroke was related to or caused by his service-connected disabilities. He is in receipt of service connection for ischemic heart disease and diabetes mellitus, type II. In a June 2019 VA medical opinion, it was noted that the Veteran had some residuals associated with his stroke in 2008, to include some slowing of thought. It was then opined by the examiner that the Veteran’s stroke and resulting residuals were less likely than not due to his service-connected ischemic heart disease disability. In support of this opinion, the examiner stated that the cause of the Veteran’s stroke was due to an occluded carotid artery. It was further explained that carotid artery occlusion, though fundamentally caused by the same process of plaque formation as ischemic heart disease, was not caused by ischemic heart disease. The examiner also indicated that the Veteran’s stroke was not caused by his diabetes disability as the Veteran’s diabetes was diagnosed years after his 2008 stroke. The Board finds the June 2019 VA medical opinion inadequate as the examiner did not provide a sufficient rationale for the opinion rendered. In this regard, the examiner did not explain how or why the Veteran’s ischemic heart disease was not the cause of his ischemic stroke. Further clarification is required especially since the examiner indicated that a carotid artery occlusion was “fundamentally caused by the same process of plaque formation as ischemic heart disease.” Moreover, according to the Centers for Disease Control and Prevention (information available to the public on the world wide web), heart disease (to specifically include coronary artery disease) increases the risk for stroke. Also, the examiner failed to address whether the stroke was aggravated by the service-connected disabilities. On remand, a new medical opinion should be obtained as to whether the Veteran’s ischemic stroke was either caused or aggravated by his service-connected ischemic heart disease disability and/or diabetes mellitus. The matters are REMANDED for the following actions: 1. Obtain a medical opinion from an appropriate examiner as pertains to the etiology of the Veteran’s ischemic stroke in April 2008. The Veteran is not required to undergo a physical examination unless deemed necessary. The claims file must be provided to the examiner. The examiner is asked to address the following: State whether it is at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran’s ischemic stroke in 2008 was either caused or aggravated by his service-connected ischemic heart disease disability and/or his diabetes mellitus. The VA examiner must provide separate findings and rationales relating to causation and aggravation. Aggravation under 38 C.F.R. § 3.310 (b) does not require that there be “permanent” worsening of the nonservice connected disability. The examiner must provide a complete rationale for his or her opinion with reference to the evidence of record. 2. Then, readjudicate the claim on appeal. L. Chu Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Casadei, 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.