Citation Nr: 21014519 Decision Date: 03/12/21 Archive Date: 03/12/21 DOCKET NO. 11-33 236 DATE: March 12, 2021 ORDER Entitlement to service connection for transient ischemic attack (claimed as stroke) is denied. FINDING OF FACT The Veteran does not have a current transient ischemic attack disability. CONCLUSION OF LAW The criteria for entitlement to service connection for transient ischemic attack have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Army from August 1968 to August 1970, including combat service in the Republic of Vietnam, and his decorations include the Combat Infantryman Badge. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In April 2018, the Veteran testified at a Travel Board hearing before the undersigned Veterans Law Judge. In May 2018 and in July 2020, the Board remanded this case for further development. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service.” Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Certain chronic diseases, including organic diseases of the nervous system such as are presumed to be incurred in or aggravated by service if manifest to a compensable degree within one year of separation from service. See 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309(a); Fountain v. McDonald, 27 Vet. App. 258 (2015). Where 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); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Entitlement to service connection for transient ischemic attack (TIA). The Veteran claims entitlement to service connection for a transient ischemic attack disability. During an April 2018 Board hearing, the Veteran expressed concern that he suffered a stroke that be believes was related to his service in Vietnam. The Board remanded the claim for further development in a May 2018. Subsequently, the Veteran was examined in October 2019 by a VA neurologist. The examiner conducted a physical examination and thorough review of the claims file and determined that the Veteran has never been diagnosed with a transient ischemic attack. The examiner explained that there is no historical or physical evidence for any type of TIA or other neurological disease process which can be classified as primary or secondary. Further, the examiner opined that the aura the Veteran described are less likely than related to any form of cerebrovascular disease and noted that an imaging study conducted in 2017 was unremarkable. The examiner concluded that there was no evidence by history or physical examination that the Veteran has suffered a TIA, nor any evidence for any ongoing sequelae for any type of acute or chronic cerebrovascular disease. Finally, the examiner noted that the Veteran has mildly flexed posture while walking which is secondary to low back pain The Veteran was afforded an additional VA examination in October 2020. Following a thorough review of the claims file, the examiner opined that is less likely than not that the veteran has a prior history of TIA. The VA examiner explained that it is more likely than not that the Veteran’s attacks of visual changes followed by headache and nausea since 2010 are consistent with migraine with aura. The examiner rationalized that the Veteran’s description of visual changes during his attacks are typical of visual aura associated with migraine. He further explained that the stereotyped nature of visual changes associated with positive visual phenomena moving across the Veteran’s vision, are classic for migrainous aura and are not consistent with TIA. The examiner also stated that the headache and nausea that follow the Veteran’s visual changes represent the headache component of the attack and provide further confirmation of the diagnosis of migraine with aura. Regarding the Veteran’s belief that he experienced a stroke and continued to have symptoms of TIA, the examiner noted April 2010, September 2011, October 2011, and October 2019 medical examinations which negated a history of TIA. The examiner also referenced a January 2011 optometry visit which showed no visual field deficits, and a November 2011 examination noting preventative treatment for the Veteran’s attacks of migraine with aura. Thus, as for element (1), the Board concludes that the Veteran does not have a current diagnosis of transient ischemic attack and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Young v. McDonald, 766 F.3d 1348 (Fed. Cir. 2014). Here, the record contains no diagnosis of transient ischemic attack by a medical professional. While the Veteran believes he has a current diagnosis of transient ischemic attack, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Id. Consequently, the Board gives more probative weight to the competent medical evidence. The Board finds that the October 2020 VA examination is probative medical evidence of record as it is based on a thorough review of the claims file, an in-person evaluation, a review of medical literature, and contains a well-supported opinion and rationale. Given the evidence discussed above, there is no current diagnosis of transient ischemic attack. (Continued on the next page)   In light of the foregoing, the Board finds that the preponderance of the evidence is against the claim. As such, service connection for transient ischemic attack must be denied. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Booker 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.