Citation Nr: 21004117 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 17-17 179 DATE: January 26, 2021 ORDER Entitlement to service connection for a stroke, to include as secondary to service-connected coronary artery disease (CAD) and/or as due to exposure to herbicides is denied. Entitlement to service connection for right eye visual impairment, to include as secondary to stroke is denied. Entitlement to service connection for a speech impediment to include as secondary to stroke is denied. Entitlement to service connection for left arm weakness to include as secondary to stroke is denied. Entitlement to service connection for left leg weakness to include as secondary to stroke is denied. Entitlement to service connection for memory loss to include as secondary to stroke is denied. FINDINGS OF FACT 1. The Veteran’s stroke is not secondary to service-connected CAD, and is not otherwise related to an in-service injury or disease. 2. The Veteran’s right eye visual impairment is not caused or aggravated by a service-connected disability. 3. The Veteran’s speech impediment is not caused or aggravated by a service-connected disability. 4. The Veteran’s left arm weakness is not caused or aggravated by a service-connected disability. 5. The Veteran’s left leg weakness is not caused or aggravated by a service-connected disability. 6. The Veteran’s memory loss is not caused or aggravated by a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for service connection for stroke due to service or service-connected CAD are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.309, 3.309, 3.310. 2. The criteria for service connection for right eye visual impairment due to service or a service-connected disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 3. The criteria for service connection for speech impediment due to service or a service-connected disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 4. The criteria for service connection for left arm weakness due to service or a service-connected disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 5. The criteria for service connection for left leg weakness due to service or a service-connected disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 6. The criteria for service connection for memory loss due to service or a service-connected disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1967 to July 1969, to include service in Vietnam.  This case has a long procedural history.  The appeal was most recently before the Board in October 2020 when it was remanded for further development.  The Board finds there has been substantial compliance with the remand directives and the Board will proceed to adjudication.  Stegall v. West, 11 Vet. App. 268 (1998).  The Veteran seeks service connection for stroke, and right eye visual impairment, speech impediment, left arm weakness, left leg weakness, and memory loss as due to stroke. Service connection may be granted for a disability resulting from disease or injury incurred or aggravated during active military service. 38 U.S.C. § 1131. Generally, service connection requires (1) the existence of a present disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Notwithstanding the lack of evidence of disease or injury during service, service connection may still be granted if all the evidence, including that pertinent to service, establishes that the disability was incurred in service. See 38 U.S.C. § 1113 (b); 38 C.F.R. § 3.303 (d); Cosman v. Principi, 3 Vet. App. 503 (1992). Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310 (a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists, and (2) that the current disability was either (a) proximately caused or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). Entitlement to service connection for a stroke, to include as secondary to service-connected CAD and/or as due to exposure to herbicides The Veteran asserts his stroke is either secondary to his service-connected CAD or due to exposure to herbicides during service. Because the Veteran has not raised, and the record does not reasonably raise, entitlement to direct service connection, the Board’s adjudication will consider only entitlement to secondary service connection. The question for the Board is whether the Veteran has a current disability that is proximately due to or the result of, or is aggravated by service-connected disability or related to his in-service exposure to herbicides. The Board concludes that, while the Veteran sustained a stroke in March 2019, the preponderance of the evidence is against finding that the Veteran’s stroke began during service or is otherwise related to an in-service injury, event, or disease, to include exposure to herbicides or is proximately due to or the result of, or aggravated by service-connected disability. 38 U.S.C. §§ 1110, 1131; Allen, 7 Vet. App. at 439; 38 C.F.R. § 3.310(a). In an August 2019 opinion and an October 2020 clarifying addendum opinion, the August 2019 VA examiner opined that the Veteran’s stroke is not related to his conceded in-service exposure to herbicides and not caused or aggravated by his service-connected CAD. The VA examiner determined that the Veteran’s stroke was a result of his right internal carotid artery (RICA) stenosis, which was caused by atherosclerotic plaques in the artery. The examiner’s review of the medical literature revealed no relationship between the development of atherosclerotic plaques in the RICA and exposure to herbicides. The VA examiner further noted that CAD is a distinct condition from atherosclerotic plaques in the coronary arteries. The examiner explained that coronary arteries are anatomically distant from the right internal carotid artery, and CAD is not a causal factor to the development of right carotid artery stenosis. Therefore, the Veteran’s stroke was less likely than not caused by his service-connected CAD. Furthermore, the examiner noted that his stenotic RICA was caused by atherosclerotic plaques, which are distinct anatomically and physiologically from his CAD. Therefore, the CAD did not affect the development of his plaques and accordingly his service-connected CAD did not aggravate his stroke. The VA examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran believes his stroke was due to herbicide exposure during service or is a result of a service-connected disability. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of anatomical relationships. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the opinion of the VA examiner. As the preponderance of the evidence is against the claim, service connection for stroke is denied. Entitlement to service connection for right eye visual impairment, to include as secondary to stroke Entitlement to service connection for a speech impediment to include as secondary to stroke Entitlement to service connection for left arm weakness to include as secondary to stroke Entitlement to service connection for left leg weakness to include as secondary to stroke Entitlement to service connection for memory loss to include as secondary to stroke The Veteran contends his right eye visual impairment, speech impediment, left arm weakness, left leg weakness, and memory loss are due to his stroke. He has not alleged that such disabilities are connected to his active duty service. Since the Board denies entitlement to service connection for the stroke, the predicate necessary for a grant of secondary service connection for the claimed residuals of the stroke have not been met. Service connection for right eye visual impairment, speech impediment, left arm weakness, left leg weakness, and memory loss right knee arthritis is denied. Allen, 7 Vet. App. at 439; 38 C.F.R. § 3.310(a). M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Eric Struening 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.