Citation Nr: 21001649 Decision Date: 01/11/21 Archive Date: 01/11/21 DOCKET NO. 13-20 373 DATE: January 11, 2021 REMANDED Entitlement to service connection for stroke and stroke residuals for substitution and/or accrued benefits purposes is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1946 to February 1949. He died in March 2012, and the appellant is his surviving spouse, who was substituted for the Veteran in his appeal. This case comes to the Department of Veterans Affairs (VA) Board of Veterans’ Appeals (Board) on appeal from an Agency of Original Jurisdiction (AOJ) rating decision dated in January 2012. This case was most recently remanded by the Board in July 2020. Unfortunately, for the reasons set forth below, another remand is necessary. Further, following the Board’s 2020 remand, the AOJ granted service connection for major depressive disorder with insomnia for accrued benefits purposes and assigned an evaluation of 70 percent effective February 23, 2011; granted entitlement to Dependents’ Educational Assistance effective from February 23, 2011; and granted service connection for the cause of the Veteran’s death. Thus, as this award constitutes a full grant of these benefits sought on appeal, those matters are no longer on appeal to the Board. 1. Entitlement to service connection for stroke residuals for substitution purposes is remanded. A VA examiner provided an etiology opinion regarding the Veteran’s strokes in September 2020 and October 2020. The opinions stated that it is less likely than not that the Veteran’s strokes or hypertension were proximately caused by his service-connected psychiatric disability. The rationale was that the Veteran’s uncontrolled hypertension was the most likely cause of his hemorrhagic stroke, and the Veteran’s hypertension was essential, and there was no identifiable cause for that type of hypertension. The opinion is inadequate because it does not address that the Veteran had two strokes—an ischemic stroke in July 2008 and a hemorrhagic stroke in July 2009. The Appellant also indicated in a February 2011 written statement that she was told a blood clot caused at least one of the strokes. Additionally, while the Defense Threat Reduction Agency (DTRA) was unable to verify that the Veteran was within 10 miles of Nagasaki or Hiroshima before July 1, 1946, which would warrant application of the principles for presumptive service connection, the Board finds that additional development is warranted for direct service connection. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994); see also October 2017 Board remand regarding the Veteran’s service in Japan. An April 2020 VA examiner indicated that it was unknown where in the Pacific the Veteran was; however, a February 2013 opinion indicates that the Veteran’s treating physician at the time of his death concluded he was exposed to radiation; an article of record indicates radiation exposure is a risk for circulatory disease; some of the Veteran’s records are unavailable; the DTRA determined he was at least in Yokohama, Yokosuka, Hara-machida, and Sendai; and a January 2013 statement indicates that the Veteran guarded medical teams traveling to and from Hiroshima and Nagasaki. Therefore, an adequate opinion regarding direct service connection must be obtained which addresses the aforementioned evidence. The matters are REMANDED for the following action: 1. Forward the record including a copy of this remand to the examiner who provided an opinion in October 2020, or if the examiner is unavailable, another suitably qualified examiner, for completion of an addendum opinion. Following review of the record, to include the October 2017 remand and the current Board remand, the examiner should respond to the inquiry below. (a.) The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater) that the Veteran’s July 2008 ischemic stroke or July 2009 hemorrhagic stroke, is etiologically related to, incurred in, or caused by the Veteran’s military active service, including radiation exposure. (b.) The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater) that the Veteran’s July 2008 ischemic stroke or July 2009 hemorrhagic stroke, to include any residuals, is proximately caused, or aggravated by, the Veteran’s service-connected depression or CAD. (c.) In providing the above opinions, the examiner should address and consider the following: the February 2013 opinion indicating that the Veteran was exposed to radiation; the article entitled “Radiation Exposure and Circulatory Disease Risk”; that some of the Veteran’s records are unavailable, but the available ones do show service in the Pacific Theater from June 11, 1946 to August 1948 and was awarded the Occupation Medal; the DTRA determined the Veteran was at least in Yokohama, Yokosuka, Hara-machida, and Sendai; and a January 2013 statement that the Veteran guarded medical teams traveling to and from Hiroshima and Nagasaki, that he guarded Japanese prisoners cleaning up the bomb sites daily for three or four months. A complete explanation for all opinions expressed must be provided. A clearly stated rationale must not be based solely on lack of documentation or records. The reasons for any opinion must include a discussion of the relevant evidence. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Smith, Associate 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.