Citation Nr: 21067229 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 16-22 559 DATE: November 3, 2021 REMANDED Service connection for a stroke (cerebrovascular accident) for substitution purposes is remanded. Service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), for substitution purposes is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1973 to August 1976 and from September 1990 to July 1991. The Veteran died in December 2019 and the Appellant is his surviving spouse. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2015 rating decision. The matter was previously remanded in June 2021. In October 2019, the Board denied service connection for a stroke, psychiatric disability, and a total disability rating based on individual unemployability. The Veteran only appealed the denials of service connection for a stroke and psychiatric disability to the United States Court of Appeals for Veterans Claims (Court). In a December 2020 Order, pursuant to a December 2020 Joint Motion for Partial Remand (JMPR), the Court vacated the Board's October 2019 decision and remanded the claims. The basis was that the October 2019 decision did not adequately address whether the Veteran's stroke is a qualifying chronic disability under 38 C.F.R. § 3.317. In September 2020, the Appellant submitted a VA Form 10182, listing the claims on appeal and service connection for the cause of the Veteran's death. The 10182 is a valid appeal of service connection for cause of death only and shall be addressed in a separate decision. In February 2021, Disabled American Veterans (DAV) submitted an informal hearing presentation on behalf of the Veteran. However, the Appellant has not submitted a VA Form 21-22, and DAV's representation does not automatically transfer to the Appellant upon the Veteran's death. Thus, the Appellant appears before the Board pro se. Should she wish to be represented by DAV, she may submit a new VA Form 21-22 1. Service connection for a stroke (cerebrovascular accident) for substitution purposes is remanded. In December 2020, the Court issued a JMPR on the basis that the Board did not adequately address whether the Veteran has a qualifying chronic disability as contemplated by 38 C.F.R. § 3.317. In June 2021, the Board remanded the Veteran's claims for an addendum opinion. A July 2021 VA medical record concludes that the Veteran's stroke is less likely than not related to service because "[a] stroke is not a medically unexplained multi-symptom illness." A July 2021 VA addendum opinion concludes that the Veteran's stroke is less likely than not related to service because "Southwest Asia exposure has not been associated with an increased risk of suffering a stroke." These opinions do not address whether the Veteran's particular stroke, not strokes in general, constitute a medically unexplained, multi-symptom illness. Also, the opinions do not specifically address the Veteran's specific exposures to dust and nerve gas. An addendum opinion is required. 2. Service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), for substitution purposes is remanded. A June 2021 VA medical opinion concludes that the Veteran's mental health condition is less likely than not related to service. The rationale is that it cannot be related to service because it was the result of his stroke. As the parties agreed in the JMPR that was granted by the Court in December 2020, the Veteran's psychiatric disorder claim is inextricably intertwined with the stroke claims remanded for further development. Accordingly, they must be considered together, and thus a decision by the Board on these claims would at this point be premature. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. An examiner should review the entire claims file and provide the following opinions: (a.) Whether the Veteran had any stroke impairment that is proximately due to hearing loss disorder. (b.) Whether the Veteran had any stroke impairment that was aggravated by hearing loss disorder. This must be addressed in a separate opinion from the "proximately due to" opinion. The examiner should provide a complete rationale for any opinions offered. If the examiner is unable to provide any requested opinion without resort to speculation, he or she should explain why this is so. 2. An examiner should review the entire claims file to determine the nature, onset, and etiology of any claimed stroke impairment. The examiner should then address each of the following questions: (a.) Please state whether the symptoms of each claimed condition are attributable to a known clinical diagnosis. If the Veteran does not now have, but previously had any such condition, when did that condition resolve? (b.) Is the Veteran's disability pattern consistent with: (1) a diagnosable but medically unexplained chronic multi-symptom illness of unknown etiology, (2) a diagnosable chronic multi-symptom illness with a partially explained etiology, or (3) a disease with a clear and specific etiology and diagnosis? (c.) If, after examining the Veteran and reviewing the claims file, it is determined that the Veteran's disability pattern is either (1) a diagnosable chronic multi-symptom illness with a partially explained etiology, or (2) a disease with a clear and specific etiology and diagnosis, then please provide an expert opinion as to whether it is related to his presumed environmental exposures experienced by the Veteran during service in Southwest Asia. (d.) Is it at least as likely as not that any diagnosed disorder had its onset directly during the Veteran's service or is otherwise causally related to any event or circumstance of service, including environmental exposures during service in Southwest Asia during the Persian Gulf War? (e.) If not directly related to service on the basis of questions (b)-(d), is any medical condition proximately due to, the result of, or caused by any service-connected disability(ies)? (f.) If not caused by another medical condition, has any disorder been aggravated by any service-connected disability(ies)? The examiner should provide a complete rationale for any opinions offered. If the examiner is unable to provide any requested opinion without resort to speculation, he or she should explain why this is so. 3. After obtaining any additional records to the extent possible, an examiner should review the entire claims file and provide the following opinions: (a.) Whether the Veteran had any psychiatric impairment. A diagnosis of posttraumatic stress disorder (PTSD) must be ruled in or excluded. (b.) Whether it is at least as likely as not that any psychiatric impairment was incurred in the Veteran's service, including but not limited to as a result of service in the Gulf War. (c.) Whether the Veteran has any psychiatric impairment that is proximately due to a stroke disorder. (d.) Whether the Veteran has any psychiatric impairment that was aggravated by a stroke disorder. This must be addressed in a separate opinion from the "proximately due to" opinion. The examiner should provide a complete rationale for any opinions offered. If the examiner is unable to provide any requested opinion without resort to speculation, he or she should explain why this is so. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Cannon, Brian 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.