BRAIN DISEASE DUE TO TRAUMA

B. MULLINS · 2026 · Case ID: 26004672

DENIED

Summary

The Veteran, who served in the U.S. Army from February 1971 to August 1973, appealed the denial of service connection for stroke residuals and nerve damage, specifically right-side hemiparesis. These claims were also pursued as secondary to a service-connected mood disorder. The Veteran experienced a stroke in 2006, years after service, with subsequent hemiparesis. While the Veteran reported an in-service fall in October 1972 where he struck his head and lost consciousness, service treatment records only documented treatment for his hand and wrist, not the stroke symptoms. The Board reviewed multiple VA opinions, including a May 2013 nurse practitioner opinion suggesting a link between PTSD and increased stroke risk, and February and March 2022 and August 2024 opinions from VA doctors. The August 2024 VA doctor opined that the stroke and hemiparesis were less likely than not related to service, citing the Veteran's post-service diagnoses of hypertension, hyperlipidemia, and diabetes as the primary causes. Regarding secondary connection to the mood disorder, multiple VA experts concluded that mood disorders are not pathophysiologically related to strokes and that the Veteran's stroke was primarily due to uncontrolled hypertension and diabetes, not aggravated by his mood disorder. The Board found the evidence persuasively against a direct or secondary link, noting the lack of medical expertise in lay opinions and the absence of a positive nexus from the VA opinions. Consequently, service connection for stroke residuals and nerve damage was denied.

Rationale

No medical opinions supported a direct link between the in-service fall and the 2006 stroke.; VA doctor opined stroke was due to post-service conditions (hypertension, diabetes), not in-service fall.; VA opinions found mood disorder not pathophysiologically related to stroke and did not aggravate it.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

14-04 498

Full Decision Text

Citation Nr: 26004672
Decision Date: 04/17/26 Archive Date: 04/17/26

DOCKET NO. 14-04 498
DATE: April 17, 2026

ORDER

Entitlement to service connection for stroke residuals, to include as secondary to service-connected mood disorder is denied

Entitlement to service connection for nerve damage as described as right side hemiparesis, to include as secondary to service-connected mood disorder, is denied.

FINDINGS OF FACT

1. The Veteran had a current disability of stroke and hemiparesis before his passing.

2. The evidence does not support that his stroke in 2006 with symptoms of hemiparesis was related to or that it was caused by a fall during service in 1972.

3. The Veteran's only service-connected condition prior to his death was mood disorder.

4. Service connection for post-traumatic stress disorder (PTSD) was finally denied in a July 2018 Board decision.

5. The Veteran's stroke residuals including nerve damage described as hemiparesis are not secondary to service-connected mood disorder and are not otherwise related to an in-service injury or disease.

CONCLUSIONS OF LAW

1. The criteria for service connection for stroke residuals are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

2. The criteria for service connection for nerve damage as described as right side hemiparesis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service with the United States Army from February 1971 to August 1973.

This matter is before the Board of Veterans' Appeals (Board) on appeal from a 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).

In July 2018, July 2021, June 2022, November 2022, and April 2024 the Board remanded these matters for further evidentiary development.

The July 2018 Board decision denied service connection for PTSD and remanded entitlement to service connection for stroke residuals and for nerve damage, both to include as secondary to psychiatric condition. Then in July 2021, the Board remanded the claims again, because the Veteran was not scheduled for examinations.

In June 2022 and November 2022 the Board remanded the claims again for new opinions requesting that the new examiner address whether the Veteran's nerve damage, described as right side hemiparesis or stroke residuals were related to service, including the evidence that the Veteran fell off of a trailer in 1972 and address whether the Veteran's nerve damage and stroke residuals were secondary to his mood disorder, noting the May 2013 VA nurse opinion must be addressed.

The Veteran passed away in January 2023, and afterwards a Request for Substitution of Claim Upon Death of Claimant was submitted. Substitution was granted and the Veteran's spouse, hereinafter Appellant, is now substituted for the claims at issue.

In April 2024, the Board requested that an addendum opinion be obtained as to whether the Veteran's nerve damage or stroke residuals were related to service, discussing (1) an October 1972 service treatment record noting that the Veteran fell off a trailer, and (2) the Veteran's report that following his six-foot fall he hit his head on a concrete wall and lost consciousness for several seconds. Also, the Board stated that the examiner must address whether the Veteran's nerve damage or stroke residuals were caused or aggravated by his service-connected mood disorder addressing the May 2013 letter from a VA nurse practitioner indicating that persons with PTSD are at an increased risk of cardiovascular disease including coronary heart disease and possible stroke.

The claims are back before the board after a supplemental statement of the case (SSOC).

Service Connection

Generally, service connection will be granted for a disability resulting from an injury or disease caused or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). A grant for service connection for a disability requires: (1) a present disability or persistent or recurrent symptoms of a disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship ("nexus") between the present disability and the in-service event, injury, or disease. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §
statement of the case (SSOC).

Service Connection

However, a disability, with no causal relationship ("nexus") to an in-service event can be considered service-connected by being proximately due to or aggravated by a service-connected disease or injury. 38 § C.F.R. §3.310(a)-(b).

To establish secondary service connection there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) competent evidence establishing a link ("nexus") between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

The Board notes that a non-service-connected disability proximally caused by a service-connected disability is considered part of the original condition. See 38 § C.F.R. §3.310(a).

In this case, the Board has reviewed all the evidence of record, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence where appropriate and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim on appeal.

Lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 C.F.R. § 3.159; see Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. See Barr v. Nicholson, 21. Vet. App. 303 (2007).

The United States Court of Appeals for the Federal Circuit has held that "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) ("[T]he Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence").

Furthermore, in determining whether service connection is warranted for a disability, VA is responsible for determining whether there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter. See 38 U.S.C. § 5107(b). If there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter then the benefit-of-the-doubt rule applies, but the benefit-of-the-doubt rule does not apply when the evidence persuasively favors one side or the other. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

1. Entitlement to service connection for stroke residuals

See section 2.

2. Entitlement to service connection for nerve damage as described as right side hemiparesis

The Appellant contends that her deceased spouse should be service-connected for stroke residuals and nerve damage, described as hemiparesis. The Veteran brought these claims prior to his passing.

While the Board is sympathetic to the Appellant's claims, the Board finds
matter then the benefit-of-the-doubt rule applies, but the benefit-of-the-doubt rule does not apply when the evidence persuasively favors one side or the other. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

1. Entitlement to service connection for stroke residuals

See section 2.

2. Entitlement to service connection for nerve damage as described as right side hemiparesis

The Appellant contends that her deceased spouse should be service-connected for stroke residuals and nerve damage, described as hemiparesis. The Veteran brought these claims prior to his passing.

While the Board is sympathetic to the Appellant's claims, the Board finds that the evidence is persuasively against the claims.

The records support that the Veteran had a left side lacunar infarction in the region of the left thalamus in 2006. See CAPRI received January 2013. After the stroke he reported issues with the right side of his body. He had problems with right-hand fine motor skills and driving. At that time, he had untreated hypertension. He was also diagnosed with diabetes. Id. The Veteran eventually had a second stroke in November 2016, after which his ability to ambulate was greatly reduced. See CAPRI received August 2017.

For example, in December 2006, the Veteran established primary care at a VA clinic. He had a stroke two months prior. He reported that he had a left thalamic lacunar infarct and woke up one morning with burning, tingling pain throughout the right side including his face, leg, chest, and torso. He reported that he was no longer able to drive, work, or make love. The treatment provider stated that the Veteran had refused to accept that he had diabetes. Testing revealed that his A1c was 11.3. See CAPRI received January 2013. The Veteran reported that he had been without primary care for a long time and that he had untreated hypertension for an unknown number of years. Id.

As to the direct service connection test, the Veteran had the current disability of residuals of stroke and nerve damage described as hemiparesis.

As to an in-service event, injury, or disease, the Veteran reported that he fell off a fuel tank trailer and struck his head on a concrete wall going unconscious for several minutes during service. The Board notes that his service treatment records show that he fell off a trailer in October 1972. After his fall he had some treatment for his hand and wrist. The Veteran was not separated from service until August 1973. See STR-Medical received May 2013. As such, he had an in-service event.

The Veteran also received service connection for mood disorder, not otherwise specified.

Therefore, the main issues before the Board are whether the Veteran's residuals of stroke and nerve damage described as hemiparesis was linked to his in-service event or was secondary to his mood disorder not otherwise specified, prior to his passing.

However, the Board finds that the evidence does not support that the Veteran's residuals of stroke and nerve damage described as hemiparesis had any link to his service or to his mood disorder.

As to whether the Veteran's stroke is directly related to his service, no opinions have supported a direct relationship between the fall in service and subsequent stroke in 2006. In August 2024, a VA doctor explained that the Veteran's stroke (nerve damage/ right hemiparesis) was less likely than not caused by the Veteran's service. The doctor explained that the Veteran was on active duty from 1971 to 1973, but he did not have a stroke until many years after in the year 2006. See C&P Examination received August 2024. The doctor considered the Veteran's statements before his passing that he fell during service, and that he was unconscious for several seconds. However, the VA doctor stated the stroke was clearly due to a stroke event in 2006 and not his fall in service. Id.

The Board also notes that records from service show that he fell in 1972, and that he had an injury to his hand and wrist. However, the Veteran did not have difficulty with ambulation or with hemiparesis during service. The evidence does not support these symptoms until the time of his stroke in 2006.

The Board considered all the evidence and finds that the evidence is persuasively against a direct link between the Veteran's stroke and nerve damage/hemiparesis and his service, including his in-service event.

As to whether the condition was secondary to his mood disorder, in May 2013, a VA family nurse practitioner stated that published literature highlights evidence from epidemiologic and clinical studies that people with PTSD are at an increased risk of cardiovascular
service show that he fell in 1972, and that he had an injury to his hand and wrist. However, the Veteran did not have difficulty with ambulation or with hemiparesis during service. The evidence does not support these symptoms until the time of his stroke in 2006.

As to whether the condition was secondary to his mood disorder, in May 2013, a VA family nurse practitioner stated that published literature highlights evidence from epidemiologic and clinical studies that people with PTSD are at an increased risk of cardiovascular disease including coronary heart disease and possible stroke. The nurse also stated that he had ongoing diabetes, hypertension, and hypercholesterolemia, all of which contributed to his stroke. See Medical Treatment Record-Government Facility received May 2013.

The Board finds that this opinion is inadequate to support service connection on a secondary basis. The Veteran was not service connected for PTSD.

As for other opinions as to secondary service connection, in February 2022 a psychologist opined that mood disorders were not known to cause stroke/hemiparesis/nerve damage. The examiner also stated that there was no indication that the Veteran's stroke/hemiparesis/nerve damage was aggravated beyond its natural progression by his service-connected mood disorder. See C&P Examination received February 2022.

In March 2022, a VA expert explained that when the Veteran separated from service in 1973, he was noted to have issues due to myopia with depression, but he didn't have a stroke during his service. He had a stroke in 2006 shown by post service records. In particular, the VA expert found that the claimed condition was less likely than not proximately due to or a result of his mood disorder. The examiner explained that mood disorders are not a known risk factor for having strokes, and that the condition was mostly due to uncontrolled hypertension. The VA expert noted that the Veteran's stroke was associated with uncontrolled hypertension in 2006 and that he also had the risk factor of diabetes mellitus prior to his stroke. See C&P Examination received March 2022.

The March 2022 examiner explained that diabetes and hypertension are associated with an increased risk of strokes in general. The VA expert in 2022 explained that after 2006 the Veteran continued to have uncontrolled diabetes and hypertension leading to another stroke in 2016 which resulted in dysarthria with right upper extremity and lower extremity weakness. The expert found that the stroke and residuals were not aggravated by his mood disorder. The expert opined that the stroke and residuals were caused by and aggravated by his diabetes and hypertension. Id.

Then in November 2023 a VA expert opined that the claimed condition was less likely than not proximately due to or the result of the Veteran's service-connected condition. The VA expert explained that as to hemiparesis, the condition was caused by disruptions in a person's brain, spinal cord, or nerves connected to the affected muscles. Additionally, no psychiatric mood disorder could cause physical obstruction of a blood vessel to cause an infarct in the brain (stroke) and subsequent hemiparesis. The expert stated that just because there was correlation between two conditions, like proposed PTSD and an increase in strokes, does not mean that there is causation. As to the pathophysiology of strokes/infarcts, mental health disorders cannot directly lead to blockages and occlusions of blood flow with a vessel. The expert also opined that the evidence he reviewed showed a natural or normal progression of the condition and not a worsening of the claimed condition. See C&P Examination received November 2023.

Then in August 2024, a VA doctor opined that the claimed condition was less likely than not proximately due to or the result of his service-connected condition. The VA doctor explained that mood disorder was not pathophysiologically related to development of stroke. The doctor explained that the records supported that the Veteran had hypertension, hyperlipidemia, and diabetes, three of the most significant risk factors for development of stroke. See C&P Examination received August 2024. The doctor also opined that the Veteran's stroke, nerve damage/hemiparesis was not aggravated by mood disorder. He explained again that the Veteran had three major risk factors for stroke, aggravation was less likely than not. Id.

The Veteran was never service connected for diabetes, hypertension or hyperlipidemia.

The Board recognizes that the Appellant might sincerely believe that her deceased spouse's mood disorder caused or aggravated his stroke/nerve damage/hemiparesis in some way.

While the Appellant may believe that the Veteran's mood disorder aggravated his
the Veteran had hypertension, hyperlipidemia, and diabetes, three of the most significant risk factors for development of stroke. See C&P Examination received August 2024. The doctor also opined that the Veteran's stroke, nerve damage/hemiparesis was not aggravated by mood disorder. He explained again that the Veteran had three major risk factors for stroke, aggravation was less likely than not. Id.

The Veteran was never service connected for diabetes, hypertension or hyperlipidemia.

The Board recognizes that the Appellant might sincerely believe that her deceased spouse's mood disorder caused or aggravated his stroke/nerve damage/hemiparesis in some way.

While the Appellant may believe that the Veteran's mood disorder aggravated his stroke/nerve damage/hemiparesis, as a lay person, she has not shown that she has specialized training sufficient to render such an opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the diagnosis and etiology of the Veteran's stroke/nerve damage/hemiparesis is a matter not capable of lay observation and requires medical expertise to determine. Accordingly, the Appellant or deceased Veteran's opinion as to the etiology of the Veteran's stroke/nerve damage/hemiparesis prior to his passing is not competent medical evidence.

The Board finds that the August 2024 opinion is sufficient to address direct service connection. The opinion was provided by a doctor and is consistent with the evidence. The opinion was sufficiently explained to allow the Board to make an informed decision. The Board finds that the August 2024 opinion is competent, credible, and gives the opinion significant weight to the issue of direct service connection.

As to secondary service connection, the Board has considered all the VA opinions above in combination. The Board finds that considering the opinions in combination they are sufficient to allow the Board to make an informed decision. The opinions when taken together are competent, credible, and the Board gives the opinions significant weight.

The Board has considered whether there has been substantial compliance with the Board remands. The Board notes that as to secondary service connection there is an opinion from a psychologist and a doctor weighing in on the issues. Moreover, the 2024 opinion considered the Veteran's fall and loss of consciousness when addressing direct service connection. The Board notes that as to secondary service connection some of the opinions considered or addressed the May 2013 letter from a VA nurse practitioner. However, the Board also notes that the May 2013 letter does not address the Veteran's mood disorder and is about PTSD, which is not service connected.

No other duty to notify or duty to assist issues have been raised. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Additionally, the Veteran has a duty to assist and cooperate with VA in developing evidence - the duty to assist is not a one-way street. See Wood v. Derwinski, 1 Vet. App. 190 (1991). 11 Vet. App. 268, 271 (1998). Considering the above, the Board will adjudicate the claim currently on appeal.

The Board finds that the evidence weighs against finding that the Veteran's mood disorder caused or aggravated his stroke/nerve damage/hemiparesis. The Board also finds that the evidence weighs against finding that the Veteran's stroke/nerve damage/hemiparesis was directly caused by his service including his in-service event.

Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for stroke/nerve damage/hemiparesis is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

B. MULLINS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Parnell, C. E.

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.
. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for stroke/nerve damage/hemiparesis is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

B. MULLINS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Parnell, C. E.

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