Citation Nr: 21027391 Decision Date: 05/05/21 Archive Date: 05/05/21 DOCKET NO. 19-26 826 DATE: May 5, 2021 REMANDED Entitlement to service connection for stroke, to include as due to Agent Orange exposure and to include as secondary to service-connected coronary artery disease (CAD). REASONS FOR REMAND The Veteran served on active duty from May 1955 to September 1959 and February 1962 to February 1978. He served in the Republic of Vietnam and earned the Bronze Star. This case comes before the Board of Veterans' Appeals (Board) on appeal of an April 2018 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) via video conference in February 2021. The Veteran contends that his strokes are due to his exposure to Agent Orange during his service in Vietnam. Although the Veteran did not claim secondary service connection, the Board finds that it is appropriate to expand the scope of the Veteran's claim to include entitlement to service connection on a secondary basis. Under 38 U.S.C. § 5103A (d)(2), VA must provide a medical examination and/or obtain a medical opinion when there is: (1) competent evidence that the Veteran has a current disability; (2) evidence establishing that he incurred an event, injury or disease in service or has a disease or symptoms of a disease within a specified presumptive period; (3) an indication the current disability or symptoms may be associated with service; and (4) there is not sufficient medical evidence to make a decision. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The third element, which requires that the evidence of record "indicate" that the claimed disability or symptoms "may be" associated with the established event, is a low threshold. Id. at 83. Here, treatment records show an old right occipital infarct and symptoms of a stroke. In addition, the Board concedes the Veteran's asserted exposure to Agent Orange. Moreover, the Veteran is service connected for CAD. Therefore, the remaining issue is whether there is a nexus between the Veteran's current diagnosis of a stroke and his service, to include his exposure to Agent Orange and his service-connected disability. An examination is thus required to obtain an opinion regarding the etiology of the Veteran's claimed stroke disability. 38 C.F.R. § 3.159(c)(4); McLendon, 20 Vet. App. at 79. The matter is REMANDED for the following action: 1. Attempt to obtain all outstanding medical records, private and VA, regarding the Veteran's stroke disability in accordance with the duties set forth in 38 C.F.R. § 3.159(c). 2. Forward the entire claims file, including this remand, to a qualified medical professional for a VA opinion to determine the etiology of the Veteran's claimed stroke disability. An in-person examination is not necessary unless the examiner determines it must be conducted to address the questions below. Based upon the claims file review, the examiner is requested to provide opinions as to the following: a.) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran's claimed stroke disability was incurred in or is otherwise attributable to service, to include exposure to Agent Orange. b.) Whether is it at least as likely as not (50 percent probability or greater) that the Veteran's claimed stroke disability was caused or aggravated by his service-connected coronary artery disease. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached. It is essential that the aggravation opinion requested above be provided. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Hetman 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.