How the Board ruled on stroke claims, 2021–2025

Stroke (direct service connection)

Direct (began in or was caused by service), or theory not stated in the Board order

31.6% granted of 225 decided cases (margin of error 25.8–37.9%). 71 granted, 154 denied, 375 sent back to VA (remanded, not decided), 50 dismissed.

What convinced the Board in granted cases

• The Board favored private medical opinions that reviewed the records, explained the link with a clear rationale, and applied medical literature on stroke risk factors to the veteran's own history. (5 of 12 decisions read; e.g. A24031298, A22000919, 23011022)
• Negative VA opinions lost weight when they gave no rationale, rested on an inaccurate fact, skipped the veteran's exposure theory, or ignored favorable treatment records and literature. (4 of 12 decisions read; e.g. 22020223, A25004649, A24014030)
• Many grants tied the stroke to a service-connected condition, most often hypertension, with treatment records naming that condition as a cause or major risk factor. (8 of 12 decisions read; e.g. A24047586, 23011022, 22020223)

Common reasons in denied cases

• The Board denied when no medical opinion supported a link and only the veteran's own belief about the cause was offered, which the Board did not treat as competent medical evidence. (5 of 12 decisions read; e.g. 21046553, A21000553, 21060769)
• Several claims, mostly for residuals of in-service heat stroke, failed because there was no current diagnosed disability. (4 of 12 decisions read; e.g. 21016656, 22020178, A24018690)
• Some claims failed because a reasoned VA opinion found no link or another cause, such as a brain blood-vessel malformation, and no comparable opinion rebutted it. (3 of 12 decisions read; e.g. 21046553, 22035658, 21028412)

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Stroke secondary to any service-connected condition

Secondary (caused or worsened by a service-connected condition)

58.8% granted of 119 decided cases (margin of error 49.8–67.3%). 70 granted, 49 denied, 170 sent back to VA (remanded, not decided), 21 dismissed.

What convinced the Board in granted cases

• The Board often granted when a private or treating doctor's favorable opinion was at least as persuasive as a negative VA opinion, so the evidence was evenly balanced or better. (7 of 13 decisions read; e.g. A24008518, 21007346, A21014186)
• Opinions carried weight when they explained how the service-connected condition, often high blood pressure, heart disease or atrial fibrillation, led to the stroke, citing medical literature and ruling out other causes. (5 of 13 decisions read; e.g. 22020630, 23041190, A25033483)
• Negative VA opinions lost weight when they rested on an inaccurate diagnosis, would not address worsening without speculating, or missed a known link in the record. (3 of 13 decisions read; e.g. 21007346, 21029518, A25000234)

Common reasons in denied cases

• The Board denied when a VA examiner gave a reasoned opinion that the service-connected condition did not cause or worsen the stroke, often pointing to other risk factors, and nothing rebutted it. (4 of 13 decisions read; e.g. 24002134, 21035622, 21034536)
• Claims failed when no medical opinion supported a link, only the veteran's own belief about the cause, or a private opinion with no real rationale. (4 of 13 decisions read; e.g. 21043065, 21020404, 21030533)
• Some claims failed because the condition said to cause the stroke was not service-connected, or because no stroke or lasting stroke residuals were shown. (6 of 13 decisions read; e.g. 21039824, A23021355, 21030533)

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Stroke secondary to hypertension

Secondary (caused or worsened by a service-connected condition)

75.6% granted of 41 decided cases (margin of error 60.7–86.2%). 31 granted, 10 denied, 38 sent back to VA (remanded, not decided), 6 dismissed.

What convinced the Board in granted cases

• The Board gave significant weight to private opinions, including from a cardiologist, that examined the veteran or reviewed the record and explained how high blood pressure damages brain arteries and leads to stroke. (4 of 13 decisions read; e.g. A25024164, 21026228, 21051610)
• Negative VA opinions lost weight when they were unclear, rested only on the hypertension rating, ignored how several service-connected conditions together contributed, or could not decide without speculating. (3 of 13 decisions read; e.g. A25024164, A25031250, A24045166)
• Many grants rested on VA examiners' own favorable opinions that explained hypertension as the main stroke risk factor, cited literature, and ruled out other causes. (5 of 13 decisions read; e.g. 23041190, A25033483, 21051408)

Common reasons in denied cases

• Most denials turned on hypertension itself not being service-connected, so the stroke could not be granted as secondary to it. (5 of 9 decisions read; e.g. 21030533, A23001382, 21039824)
• There was no competent medical opinion linking the stroke to hypertension, and the veteran's own belief was not competent medical evidence. (2 of 9 decisions read, few decisions; e.g. 21030533, A23011652)

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Stroke secondary to heart disease

Secondary (caused or worsened by a service-connected condition)

Small sample: 21 decided cases, too few for a reliable percentage. 10 granted, 11 denied, 27 sent back to VA (remanded, not decided), 2 dismissed.

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Stroke secondary to diabetes

Secondary (caused or worsened by a service-connected condition)

Small sample: 13 decided cases, too few for a reliable percentage. 7 granted, 6 denied, 19 sent back to VA (remanded, not decided), 2 dismissed.

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Stroke secondary to PTSD

Secondary (caused or worsened by a service-connected condition)

Small sample: 10 decided cases, too few for a reliable percentage. 5 granted, 5 denied, 14 sent back to VA (remanded, not decided), 0 dismissed.

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