Citation Nr: 21011160 Decision Date: 03/01/21 Archive Date: 03/01/21 DOCKET NO. 14-40 547 DATE: March 1, 2021 REMANDED Entitlement to service connection for ischemic stroke is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1967 to April 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2012 rating decision. The Veteran testified at a Board hearing in November 2016. In February 2019, the Board issued a decision denying the entitlement to service connection for ischemic stroke. The Veteran appealed to the United States Court of Appeals for Veterans Claims (Court). In December 2019, the Court granted a joint motion for remand, thereby vacating the Board’s February 2019 decision and remanding the Veteran’s claim back to the Board. *** The Veteran seeks service connection for residuals of a July 2010 cerebrovascular accident (CVA), also described as an ischemic stroke. See 04/25/2011, Medical Treatment Record – Government Facility, at 1. The Veteran asserts that his ischemic stroke is secondary to his service-connected coronary artery disease. He has also submitted literature suggesting a relationship between PTSD and ischemic stroke. The Veteran is also service-connected for PTSD. In March 2020, the Board remanded the Veteran’s claim for a new VA examination. In the relevant remand directive, the Board instructed the VA examiner to opine whether the Veteran’s July 2010 cerebrovascular accident was at least as likely as not proximately due to either his service-connected coronary artery disease or his service-connected PTSD. In the alternative, the Board instructed the examiner to opine whether any residuals of the July 2010 cerebrovascular accident have at least as likely as not been aggravated (worsened beyond its natural progression) by his service-connected coronary artery disease or his service-connected PTSD. The Veteran underwent a new VA examination in January 2021. The VA examiner opined that the Veteran’s July 2010 cerebrovascular accident was less likely than not caused or aggravated by a service-connected disability. The examiner’s rationale was that “there is no data that substantiates a correlation of the Veteran’s July 2010 cerebrovascular accident to be corrected to either his service-connected coronary artery disease or his service-connected PTSD, adding that “[t]here was a detailed work-up at the time of stroke and no signs of the possible etiology of the arrhythmia which could have been correlated”. Regarding aggravation, the examiner simply indicated that “[t]here is no correlation of the Veteran’s cerebrovascular accident to have been made worse by his coronary artery disease or PTSD”. After review, the Board finds that the January 2021 VA opinion is not supported by a clear medical rationale. Rather, the examiner’s rationale is essentially a restatement of her conclusions. Furthermore, the opinion does not show adequate consideration of the favorable evidence (medical opinion and literature) submitted by the Veteran. While the opinion acknowledges review of this evidence, it does not address its substance. Rather than engaging the favorable evidence, the opinion does not address. As such, the factual underpinnings of the opinion are weak. Finally, the Board finds that the opinion does not properly answer the question regarding aggravation, as posed by the Board in the March 2020 remand. As mentioned, the Board asked the examiner to opine whether any residuals of the July 2010 cerebrovascular accident have at least as likely as not been aggravated (worsened beyond its natural progression) by his service-connected coronary artery disease or his service-connected PTSD. The Board finds no indication that the January 2021 opinion considered whether any stroke residuals have been aggravated by one or more of the Veteran’s service-connected disabilities. As an adequate opinion is not of record, another remand is necessary. The Veteran stated in an April 2020 correspondence that he had submitted VA and non-VA records and has not more evidence to submit. He added that the annual employment physicals are no longer available and he was not able to obtain these records. This matter is REMANDED for the following action: Obtain an addendum opinion regarding the Veteran’s claim of service connection for residuals of ischemic stroke. The examiner is to respond to the following: (a.) Is the Veteran’s July 2010 cerebrovascular accident at least as likely as not proximately due to either his service-connected coronary artery disease or his service-connected PTSD? (b.) If not, then is it at least as likely as not that any residuals of the July 2010 cerebrovascular accident have been aggravated (worsened beyond its natural progression) by either his service-connected coronary artery disease or his service-connected PTSD? **The examiner is to consider and discuss the medical statement from Dr. R.A.B., indicating that the Veteran’s cerebrovascular accident was secondary to his coronary artery disease. See12/19/2016 Correspondence. The examiner is to also consider and discuss the literature submitted by the Veteran, indicating that people who suffer from PTSD may be at a higher risk for strokes. 07/05/2013 Web/HTML Documents.** The examiner is to provide a comprehensive medical rationale for any opinion offered. The examiner is to consider lay reports from the Veteran along with pertinent medical evidence, including medical literature submitted by him, as referenced above. If the examiner cannot offer an opinion without resort to speculation, he or she should explain why and state what additional evidence, if any, would be required to offer an opinion. Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P. López, 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.