CEREBROVASCULAR ACCIDENT (STROKE)

Summary

The veteran, who served in the United States Army from August 1961 to February 1964 and again from July 1976 to October 1981, passed away in January 2024. The appellant, recognized as a substitute claimant in June 2024, appealed the April 2025 rating decision concerning service connection for residuals of a cerebrovascular accident (stroke). The appellant contended that the Veteran's stroke and its residuals were due to his active-duty service, specifically claiming secondary service connection to hypertension. The Board reviewed the evidence of record, including private treatment records and a February 2025 VA medical opinion. The private records confirmed the stroke and its residuals, such as confusion and word-finding difficulty. The VA examiner noted the Veteran's hypertension and treatment with luspatercept, concluding that hypertension was the most likely causal pathology for the stroke. The Board assigned significant probative weight to this private medical opinion, finding it well-reasoned and noting the absence of contrary medical evidence on the secondary service connection theory. Consequently, the Board found the criteria for secondary service connection met, granting entitlement to service connection for residuals of stroke secondary to hypertension.

Rationale

Private treatment records confirm stroke and residuals.; VA examiner found hypertension to be the most likely causal pathology.; No contrary medical opinion on secondary service connection.

Full Decision Text

Citation Nr: A26040616
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 250708-553315
DATE: April 30, 2026

ORDER

Entitlement to service connection for residuals of cerebrovascular accident (stroke), to include as secondary to hypertension, is granted.

FINDING OF FACT

The probative evidence of record is at least in approximate balance that the Veteran's residuals of stroke are proximately due to the Veteran's service-connected hypertension.

CONCLUSION OF LAW

The criteria for entitlement to service connection for residuals of stroke have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served in the United States Army on active duty from August 1961 to February 1964 and from July 1976 to October 1981.

The Veteran died in January 2024. The Appellant was recognized as a substitute claimant for the Veteran in June 2024. 

The issue comes before the Board of Veterans' Appeals (Board) on appeal from an April 2025 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO).

In the July 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Appellant elected the Hearing docket. On August 28, 2025, the Appellant withdrew the hearing request.

Therefore, the Board may only consider the evidence of record at the time of the April 2025 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Appellant or representative within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Entitlement to service connection for residuals of stroke 

The Appellant contends that the Veteran's stroke and its residuals were due to his active-duty service. 

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Service connection may be warranted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that disease was incurred in service. 38 C.F.R. § 3.303 (d).

As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004).

However, service connection on a secondary basis, as the Veteran has claimed, requires evidence sufficient to show: (1) that a current disability exists; and (2) that the current disability was either caused or aggravated by a service-connected disability. 38 C.F.R. § 3.310.

Additionally, when a veteran's claim includes a secondary service connection theory of entitlement, VA must provide an opinion as to whether the veteran's claimed disability is proximately due to or aggravated by his service-connected disabilities. See 38 C.F.R. § 3.310; see also, El-Amin v. Shinseki, 26 Vet. App. 136, 138-40 (2012). Causation and aggravation are independent concepts, and VA must ensure medical examinations have separate findings and rationales. See Atencio v. O'Rourke, 30 Vet. App. 74, 91 (2018).

The Veteran's private
 disability. 38 C.F.R. § 3.310.

Additionally, when a veteran's claim includes a secondary service connection theory of entitlement, VA must provide an opinion as to whether the veteran's claimed disability is proximately due to or aggravated by his service-connected disabilities. See 38 C.F.R. § 3.310; see also, El-Amin v. Shinseki, 26 Vet. App. 136, 138-40 (2012). Causation and aggravation are independent concepts, and VA must ensure medical examinations have separate findings and rationales. See Atencio v. O'Rourke, 30 Vet. App. 74, 91 (2018).

The Veteran's private treatment records show that he had a stroke in May 2021, and that he experienced residuals as a result of the stroke. See private treatment records. The June 2021 private treatment record also noted that the Veteran's stroke symptoms, such as confusion and word finding difficulty, had largely resolved but that he still struggled with difficulty getting words out. See June 2021 private treatment record. Thus, the first element of secondary service connection has been met. 

The question now comes to determine whether the Veteran's stroke and residuals were caused or aggravated by a service-connected disability.

The Appellant was provided a VA medical opinion in February 2025, in which the examiner confirmed that the Veteran had a stroke and experienced residuals. See February 2025 VA medical opinion. The examiner provided a medical opinion regarding the Veteran's confirmed toxic exposure risk activity (TERA), specifically his herbicide agent exposure during service. The examiner noted that the Veteran was treated with luspatercept in April 2021, but the medication was discontinued due to his stroke and hypertension. Id; see also, June 2021 private treatment record. The examiner summarized the Veteran's medical records in the aftermath of his stroke, and found that he still experienced higher blood pressure and was diagnosed with a brain tumor. The examiner concluded that the Veteran's stroke had several risk factors, "but the most likely causal pathology was hypertension and acute elevation after treatment with luspatercept." Id. 

The Board assigns significant probative weight to the February 2025 private medical opinion, as the opinion was supported by a fully articulated rationale with consideration of the Veteran's medical history, lay statements, and established medical literature. See Prejean v. West, 13 Vet. App. 444 (2000); see also, Guerrieri v. Brown, 4 Vet. App. 467 (1993). Moreover, the Board notes that there is no competent contrary medical opinion on the theory of secondary service connection. 

Thus, as the competent probative medical evidence of record demonstrates the Veteran's residuals of stroke were secondary to his service-connected hypertension, the criteria for secondary service connection have been met, and the Appellant's claim is granted.

 

 

JENNIFER HWA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Matta, Martina Y.

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.