Citation Nr: 21010987 Decision Date: 02/26/21 Archive Date: 02/26/21 DOCKET NO. 18-02 617 DATE: February 26, 2021 ORDER Entitlement to service connection for cerebrovascular disease with major neurocognitive disorder as secondary to service-connected coronary artery disease is granted. FINDING OF FACT The Veteran’s cerebrovascular disease with major neurocognitive disorder is due to his service-connected coronary artery disease. CONCLUSION OF LAW The criteria for entitlement to service connection for cerebrovascular disease with major neurocognitive disorder as secondary to service-connected coronary artery disease have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from October 1967 to September 1971. The Veteran testified before the undersigned at a January 2021 Board Hearing held via videoconference. The record contains a transcript of the hearing. While the record contains evidence not yet considered by the agency of original jurisdiction (AOJ), the claim may be granted on the current record. Therefore, the Board may proceed to the merits. See 38 C.F.R. § 20.1305(c). The Veteran that he developed cerebrovascular disease with major neurocognitive disorder as a result of his service-connected coronary artery disease (CAD). The record contains conflicting opinions as to the etiology of his condition. For instance, a December 2016 VA examiner provided a negative nexus opinion based on the lack of a documented cerebral vascular accident and clinical features that the examiner opined indicated mental decline associated with the normal aging process. Additionally, the October 2017 VA examiner opined that the Veteran’s neurocognitive disorder was less likely than not proximately due to or the result of the Veteran’s service-connected CAD. The examiner reasoned that the onset of memory and cognitive problems was gradual and suggestive of Alzheimer’s. However, the record contains favorable opinions. A September 2016 Neuropsychological Report provides a detailed analysis of the Veteran’s condition and concludes that the major neurocognitive disorder is “secondary to medical conditions including vascular disease.” The private psychologist provided an April 2017 addendum clarifying that the clinical features of the Veteran’s cognitive impairments were consistent with causation by vascular disease and he specifically opined: “it is clear that [the Veteran’s] known diagnosis of coronary artery disease is the vascular disease etiology causing his cognitive impairment.” The psychologist – Dr. H. – is also identified as the Director of Neuropsychology Training and Laboratory, as well as an Associate Professor in Psychiatry & Behavioral Sciences, at a university. Dr. H. provided an updated May 2018 Neuropsychological Report which evaluated the Veteran’s current symptoms, impairments, and clinical features of the neuropsychological condition. The psychologist diagnosed major neurocognitive disorder secondary to cerebrovascular disease. Dr. H. also provided a March 2020 letter in which she expressly opined on the etiology of the Veteran’s condition and discussed her reasons for disagreeing with the VA examiner’s conclusion and the VA adjudicators’ conclusions that the Veteran’s major neurocognitive disorder was not caused by his service-connected CAD. Dr. H. noted that the diagnosis expressly contemplates decline significantly greater than that which would be expected as due to ageing. Moreover, Dr. H. convincingly explained the clinical features regarding onset and progression that distinguished age-related dementia and Alzheimer’s from the Veteran’s condition as suggested by the VA examiners. Dr. H. also noted logical and factual incompleteness in the VA examiner’s reasoning (such as relying on lack of evidence of a cerebral vascular accident prior to the decline when such evidence would be expected after the decline and that there was in fact evidence of cerebrovascular disease). While Dr. H. provided further details, it is enough to say that, particularly when the various reports and letters are considered together, Dr. H.’s opinions, as a whole, are thorough, well-reasoned, and quite convincing as compared to the VA examiners’ opinions. Dr. H.’s opinion warrants substantial probative value which, at minimum, puts the evidence in equipoise regarding whether the major neurocognitive disorder was caused by the Veteran’s CAD. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (“most of the probative value of a medical opinion comes from its reasoning”); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A] medical opinion…must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions.”). Finally, the record also includes a June 2020 Private Opinion Letter from the Veteran’s treating physician at a long-term care center. The physician opined that the CAD and hypertension are conditions “with known association with Vascular Dementia.” This opinion provides additional probative weight in favor of the claim. Nieves-Rodriguez, 22 Vet. App. at 304. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current major neurocognitive disorder is proximately due to his service-connected CAD. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for major neurocognitive disorder is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kerry Hubers 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.