Citation Nr: 21023238 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 14-34 963 DATE: April 20, 2021 REMANDED 1. Entitlement to service connection for residuals of stroke is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from February 1963 to February 1967, including service in the Republic of Vietnam. These matters come before the Board of Veterans; Appeals (Board) on appeal from a February 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. 1. Entitlement to service connection for residuals of a stroke is remanded. The Board remanded this matter in May 2018, October 2020, and most recently in January 2021. The Veteran was afforded a VA central nervous system examination in June 2019. The VA examiner opined that the Veteran’s stroke and resultant residuals are less likely than not due to his ischemic heart disease, noting that his stroke was caused by a left occluded artery that itself was caused by the same process of plaque formation as ischemic heart disease. The VA examiner then opined that the Veteran’s stroke and resultant residuals are less likely than not incurred by diabetes mellitus, noting that diabetes was diagnosed four years after his stroke. In its January 2021 remand, the Board found the rationale regarding secondary causation by service-connected ischemic heart disease was inadequate and remanded for a new opinion in this regard, as well as for opinions regarding aggravation. The Board also noted in the remand that according to the “Centers for Disease Control and Prevention (information available to the public on the world wide web), heart disease (to specifically include coronary artery disease) increases the risk for stroke.” In a January 2021 addendum opinion, a VA examiner opined that the Veteran’s stroke and residuals are less likely than not proximately due to or the result of his ischemic heart disease, noting that ischemic heart disease is not an established primary etiology of stroke. The VA examiner then opined that the Veteran’s stroke was at least as likely as not proximately due to or the result of his service-connected diabetes, noting that diabetes represents a well-established primary etiology of stroke. It was further noted that as the condition is secondary to diabetes, it cannot have been aggravated by diabetes. A Board remand confers upon an appellant the right to compliance with that order. Stegall v. West, 11 Vet. App. 268, 271; D’Aries v. Peak, 22 Vet. App. 97, 105 (2008) (holding that there must be substantial compliance with the terms of a Court or Board remand). When VA undertakes to provide a Veteran with an examination, that examination must be adequate for VA purposes. Barr v. Nicholson, 21 Vet. App. 303 (2007). Here, the January 2021 VA examiner did not provide an adequate rationale in that he failed to address the CDC information provided by the Board and returned an etiology opinion regarding the Veteran’s diabetes that contradicts the prior opinion. The Board notes that the Veteran’s stroke was four years prior to the Veteran’s being diagnosed with pre-diabetes and then diabetes mellitus. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician to answer the following questions: Are the Veteran’s residuals of a stroke at least as likely as not proximately due to service-connected ischemic heart disease? Are the Veteran’s residuals of a stroke at least as likely as not aggravated by service-connected ischemic heart disease? Are the Veteran’s residuals of a stroke at least as likely as not proximately due to service-connected diabetes mellitus, type II? Are the Veteran’s residuals of a stroke at least as likely as not aggravated by service-connected diabetes mellitus, type II? Are the Veteran’s residuals of a stroke at least as likely as not proximately due to the aggregate impact of the service-connected ischemic heart disease and diabetes mellitus? Are the Veteran’s residuals of a stroke at least as likely as not aggravated due to the aggregate impact of the service-connected ischemic heart disease and diabetes mellitus? The VA examiner’s attention is invited to the April 10, 2008 and April 13, 2008 private treatment records from St. Mary’s Medical Center which pertain to his April 2008 stroke. The VA examiner should discuss the Veteran’s risk factors for stroke as well as whether the significance, if any, of the date that the Veteran’s diabetes mellitus was diagnosed. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Brian P. Keeley 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.