Citation Nr: 21011884 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 20-12 173 DATE: March 2, 2021 ORDER Entitlement to service connection for stroke residuals as secondary to Traumatic Brain Injury (TBI) and migraine headaches, is granted. FINDING OF FACT The Veteran’s stroke residuals are proximately due to his service connected TBI and TBI related migraine headaches. CONCLUSION OF LAW The criteria for service connection for stroke residuals as secondary to his TBI and TBI and migraine headaches are 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 served on active duty from October 2002 to April 2014. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from the October 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).  Law and Analysis The Veteran contends that he has current residuals of a stroke that are attributable to traumatic brain injury (TBI) and migraine headaches. See December 2020 Appellate Brief. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be granted on a secondary basis for a disability which is proximately due to, aggravated by, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The Veteran has been diagnosed with a stroke and residuals of stroke during the pendency of the claim. See October 2017 VA examination and report; June 2016 VA treatment record. Therefore, the Veteran has met the first element of service connection. The dispositive issue is whether there is medical evidence establishing a link between his stroke residuals and service-connected disability. The Board finds that there is. In conjunction with his claim, the Veteran was provided a VA examination in October 2017 to determine the nature and etiology of his disability. The examiner noted that headaches are frequent sequela of TBI, and the Veteran’s record substantiates his stroke. The examiner found that, while migraine could cause a stroke, the available history did not suggest that the April 2016 stroke began during a migraine headache. Further, while traumatic dissection of a carotid or vertebral artery can cause stroke, tests and imaging of the Veteran’s head and neck showed no evidence of artery dissection. In the absence of concurrent migraine or artery dissection, the Veteran’s stroke was less likely as not to have been caused by his TBI. See October 2017 VA examination and report. The Veteran provided an October 2020 medical opinion from a private neurologist, Dr. A.S.D.D., who specializes in concussion/mild TBI and neurophysiology/neuromuscular diseases. Dr. A.S.D.D. noted he reviewed the Veteran’s claims file and interviewed him, and recounted the Veteran’s medical history, including the October 2017 VA examination report. He opined that the Veteran’s stroke residuals are at least as likely as not secondary to his service-connected TBI and migraine residuals. The rationale was that numerous studies suggest that people with TBI and/or migraine headache are at higher risk for suffering strokes. Dr. A.S.D.D. provided an overview of the studies and their outcomes and provided a medical explanation addressing the multiple mechanisms by which TBI and/or migraine headache could cause a stroke. Dr. A.S.D.D. concluded that TBI can lead to numerous long-term consequences; thus, the Veteran was at a higher risk of stroke due to his TBIs and migraine headaches. The Board gives more probative weight to the opinion of Dr. A.S.D.D. While both the VA examiner and Dr. A.S.D.D. are competent to provide an opinion, Dr. A.S.D.D. has specialized training and experience in TBI. Further, he provided a detailed review of relevant medical research and a more in-depth medical explanation that addressed the multiple mechanisms that could connect TBI and associated migraine headache with a subsequent stroke. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008). (Continued on the next page)   Accordingly, the Board finds that service connection for stroke residuals is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Marissa Caylor Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Department of Veterans Affairs 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.