Citation Nr: 22044648 Decision Date: 08/06/22 Archive Date: 08/06/22 DOCKET NO. 13-10 846 DATE: August 6, 2022 REMANDED Entitlement to service connection for residuals of a stroke, including as secondary to service-connected anxiety disorder with posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from February 1975 to April 1976. The Board acknowledges that this appeal has a long procedural history. Most recently, in February 2021, the Board denied the Veteran's appeal. An April 2022 Court of Appeals for Veterans Claims (Court) order vacated the Board's decision and adopted a Joint Motion for Remand (JMR) for reconsideration of the Veteran's claim. The claim has been returned to the Board for further consideration. Entitlement to service connection for residuals of a stroke, including as secondary to service-connected anxiety disorder with PTSD, is remanded. As discussed above, in April 2022, the Court issued a JMR vacating and remanding the appeal for additional action. Specifically, the Court found that the Board erred by relying on an inadequate medical opinion. In this regard, the Court noted that a May 2016 VA examiner opined that the Veteran's cerebrovascular accident (CVA) is likely secondary to vasculopathic risk factors including a history of cocaine abuse and concluded that the condition was not associated with service. However, the record contains an August 2009 mental health outpatient note reporting that the Veteran relapsed on cocaine and alcohol due to his service-connected acquired psychiatric disorder. This relapse occurred prior to the Veteran's stroke in November 2010. The Court found that the issue of whether the Veteran's service-connected acquired psychiatric disorder caused his cocaine relapse, which in turn caused his CVA, was raised by the record. See Robinson v. Peake, 21 Vet. App. 545, 552-56 (2008) (the Board is required to address issues raised by either the claimant or the evidence of record); see also Allen v. Principi, 237 F.3d 1368, 1381 (Fed. Cir. 2001) ("38 U.S.C. § 1110 does not preclude compensation for an alcohol or drug abuse disability secondary to a service-connected disability or use of an alcohol or drug abuse disability as evidence of the increased severity of a service-connected disability"). The Court then found that the May 2016 VA examiner did not address the Veteran's medical history, including the August 2009 VA outpatient note indicating that cocaine abuse was due to his service-connected acquired psychiatric disorder. Accordingly, a remand is warranted in order to obtain a new medical opinion that addresses the August 2009 VA outpatient note and whether the stroke was secondary to the Veteran's service-connected acquired psychiatric disorder, based on a theory that the anxiety caused substance abuse, which in turn led to the stroke. The matter is REMANDED for the following action: Obtain a medical opinion from a qualified clinician for the Veteran's residuals of a stroke claim. The electronic claims file must be made available to the clinician for review in connection with the request for an opinion. If the reviewing clinician determines that an in-person examination (including via telehealth interview) is needed in order to answer the questions posed, then such should be scheduled. After reviewing the claims file, the reviewing clinician should address the following: Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's service-connected anxiety disorder with PTSD caused or aggravated the Veteran's stroke? The reviewing clinician must address the August 2009 VA outpatient note reporting that the Veteran relapsed on cocaine and alcohol due to his service-connected acquired psychiatric disorder, based on the theory that the anxiety caused substance abuse, which in turn led to the stroke. (Continued on the next page) The reviewing clinician must fully explain the rationale for any opinion, with citation to supporting clinical data/lay statements, as deemed appropriate. If the reviewing clinician cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide supporting rationale as to why an opinion cannot be made without resorting to speculation. N. Breitbach Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Miller, 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.