Citation Nr: 21027996 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 17-04 998 DATE: May 10, 2021 REMANDED Entitlement to service connection for headaches, to include as secondary to stroke and/or coronary artery disease, is remanded. Entitlement to service connection for vision loss of the right eye, to include as secondary to stroke and/or coronary artery disease, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1961 to February 1969, and from July 1990 to January 1991. He also served in the Army National Guard and had a period of Active Duty for Training (ACDUTRA). These matters initially came before the Board of Veterans' Appeals (Board) on appeal from a June 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In November 2018, the Veteran testified at a videoconference hearing before the undersigned; a transcript of that hearing is of record. In August 2019, the Board remanded the Veteran's appeals to the agency of original jurisdiction for further evidentiary development. Subsequently, an October 2020 rating decision granted entitlement to service connection for persistent depressive disorder (originally claimed as depression) and peripheral neuropathy of the right lower extremity. A February 2021 rating decision then granted service connection for peripheral neuropathy of the right upper extremity and a stroke. As these decisions constitute a full grant of the benefits sought on appeal for depression, peripheral neuropathy of the right upper extremity, peripheral neuropathy of the right lower extremity, and stroke disabilities, there remain no issues of controversy for adjudication by the Board on those four claims. See Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997). A Supplemental Statement of the Case was also issued in February 2021, continuing the denial of service connection for vision loss of the right eye and chronic headaches. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). Entitlement to service connection for headaches, to include as secondary to stroke and/or coronary artery disease, and for vision loss of the right eye, to include as secondary to stroke and/or coronary artery disease, are remanded. The Veteran has been diagnosed with acute intermittent tension headaches and with pseudophakia and posterior vitreous detachment of the right eye. The Board remanded these claims in August 2019, directing the agency of original jurisdiction to obtain a medical opinion as to causation and aggravation by the service-connected coronary artery disease. A medical opinion for the right eye condition was prepared in December 2019. The examiner stated that the impairment of the Veteran's vision in his right eye was "due to diabetic retinopathy bilateral with macular edema and pseudophakia of right eye and not due to Veteran's service-connected condition." The examiner then said that the Veteran's condition was not aggravated beyond its natural progression by the service-connected condition, with no further discussion. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). As the medical opinion for the Veteran's right eye condition did not provide a reasoned explanation for its conclusions, it is inadequate for VA purposes and remand is necessary for a new VA examination and opinion. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A medical opinion for the Veteran's headaches was prepared in January 2020. The examiner stated that the Veteran's headaches were not caused by coronary artery disease because the conditions are not medically related, and the headaches are a separate entity which is unrelated to the coronary artery disease. The examiner stated that it is less likely than not that the headaches are aggravated by coronary artery disease because the headaches are subjective and there is no objective evidence to support a claim of headache severity. These conclusory statements did not provide an adequate explanation of the examiner's conclusions. Although medical evidence is required to establish a baseline for aggravation, "objective evidence is not required unless specified in the regulation. Petitti v. McDonald, 27 Vet. App. 415, 427 (2015) (a regulation that "does not speak to the type of evidence required... certainly does not, by its own terms, restrict evidence to 'objective' evidence"). Therefore, the medical opinion is inadequate for VA purposes and remand is necessary for a new VA examination and opinion. See Barr, supra. In addition, during his December 2019 examination for headaches, the Veteran stated that his headaches onset when he suffered from a stroke in 1997. A February 2021 rating decision granted service connection for that stroke. The evidence calls for a medical opinion as to causation or aggravation by the Veteran's newly service-connected stroke. The matters are REMANDED for the following actions: 1. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's headache disability. The clinician should opine: (a.) Whether the Veteran's headache disability is at least as likely as not proximately due to or aggravated by his service-connected coronary artery disease, and (b.) Whether it is at least as likely as not proximately due to or aggravated by his service-connected stroke. 2. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's vision loss of the right eye. The clinician should opine: (a.) Whether the Veteran's vision loss of the right eye is at least as likely as not proximately due to or aggravated his service-connected coronary artery disease, and (b.) Whether it is at least as likely as not proximately due to or aggravated by his service-connected stroke. A complete rationale for all opinions must be provided. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Dean, Associate 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.