Citation Nr: A21017946 Decision Date: 11/05/21 Archive Date: 11/05/21 DOCKET NO. 210803-176173 DATE: November 5, 2021 ORDER Entitlement to service connection for stroke residuals is granted. FINDING OF FACT The competent and probative evidence is at least in equipoise as to whether the Veteran's stroke residuals had its onset in or are otherwise related to the Veteran's period of active service. CONCLUSION OF LAW The criteria for entitlement to service connection for stroke residuals have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1959 to May 1987. This matter comes to the Board of Veterans' Appeal (Board) on appeal from a June 2021 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In the VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD), the appellant elected the Evidence Submission option; therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the appellant or his or her representative with the VA Form 10182 or within 90 days of receipt of the VA Form 10182. 38 C.F.R. § 20.303. This case has been advanced on the docket pursuant to 38 C.F.R. § 20.902(c). Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). As a general matter, establishing service connection requires competent evidence of (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. Certain chronic diseases will be presumed related to service if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.303, 3.307, 3.309; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). To be "shown in service," the disease identity must be established and the diagnosis not subject to legitimate question. Walker at 1335. All subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. Id. The Veteran is competent to report symptoms and experiences he can observe. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). The VA must give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed Cir. 2009). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 57-58 (1990); 38 C.F.R. § 3.102. 1. Entitlement to service connection for stroke residuals The Veteran contends that his stroke residuals are related to his period of active service. After reviewing the pertinent lay and medical evidence of record, the Board finds that the competent and probative evidence is evenly balanced as to whether the Veteran's stroke residuals had its onset in or are otherwise related to his period of active service. The Board is bound by favorable findings identified by the RO in its June 2021 rating decision. Specifically, favorable findings included a current disability, cardiovascular stroke, that is recognized as a chronic disease under 38 C.F.R. § 3.309(a) and a head injury complicated by migraines during active service on or about December 5, 1983. 38 C.F.R. § 3.104(c). Service treatment records demonstrate that the Veteran presented with complaints of right temporal vision loss, confusion, slurred speech, and left arm numbness in December 1983. The clinical impression was transient ischemic attack (TIA). After the symptoms subsided, the Veteran developed severe headaches and was admitted to the hospital. He was evaluated by neurology and they felt that he had a complicated migraine pattern. A digital stress angiogram was performed and showed no evidence of carotid pathology in the cervical region and no vascular abnormality of the Circle of Willis intracranially. The Veteran was afforded a VA examination in June 2021. The examiner opined that it is less likely than not that the Veteran's stroke was the result of a head injury or migraines from service. The examiner determined that the Veteran had an ischemic stroke that is primarily caused by atherosclerosis, which would not result from a car accident causing a head injury and migraines. The Veteran submitted a private medical opinion dated February 2021. The examiner opined that it is as likely as not that the condition is directly and causally related to the Veteran's period of service. The examiner noted the Veteran began experiencing symptoms of a TIA in the early 1980s. The examiner further noted that the Veteran had a series of mini strokes and stroke residuals persisted through the present. He reasoned that stroke residuals qualified for service connection because the onset of the condition was during active military service. Based on the medical opinions discussed above, the Board finds that the evidence is in equipoise as to whether the Veteran's stroke residuals are etiologically related to service. To the extent that there is any reasonable doubt, that doubt will be resolved in the Veteran's favor. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Accordingly, the Veteran's service connection claim for stroke residuals is granted. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Ball Jackson, 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.