Discussion in 'General Medical' started by boogalee, Feb 26, 2011.
Can cataracts be compensated in relation to secondary to diabetes?
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Board of Veterans' Appeals Decisions Search
Citation Nr: 1038484
Decision Date: 10/13/10 Archive Date: 10/22/10
DOCKET NO. 05-21 621A ) DATE
On appeal from the
Department of Veterans Affairs (VA) Regional Office (RO)
in Winston-Salem, North Carolina
Entitlement to service connection for a disability of the eyes,
to include cataracts, as secondary to the service connected
ATTORNEY FOR THE BOARD
Katie K. Molter
The Veteran served on active duty from November 1963 to November
This appeal before the Board of Veterans' Appeals (Board) arises
from a July 2004 rating decision of the RO which denied the
The matter was previously before the Board in November 2007 and
September 2009 and was remanded for further development. The
September 2009 remand directed the RO to schedule the Veteran for
a VA eye examination. The RO sent the Veteran a November 19,
2009, letter regarding his VA examination. The record shows that
the Veteran failed to report to his December 9, 2009, VA
examination. The RO attempted to contact the Veteran by
telephone to inquire as to why he failed to report to his
examination but was unable to reach the Veteran. Thus, the Board
finds that RO complied with the September 2009 remand and the
Board can proceed with a decision on the merits of the issue on
FINDING OF FACT
The evidence of record is in relative equipoise as to whether
there is a causal relationship between the Veteran's service-
connected diabetes mellitus and his disability of the eyes,
identified as cataracts.
CONCLUSION OF LAW
Resolving all reasonable doubt in favor of the Veteran, a
disability of the eyes, identified as cataracts, is proximately
due to or the result of a service-connected disease or injury.
38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102,
REASONS AND BASES FOR FINDING AND CONCLUSION
I. Duties to Notify and Assist
VA's duties to notify and assist claimants in substantiating a
claim for VA benefits are found at 38 U.S.C.A. §§ 5100, 5102,
5103, 5103A, 5107, 5126 (West 2002 & Supp. 2009); 38 C.F.R. §§
3.102, 3.156(a), 3.159, 3.326(a) (2009). VA's notice
requirements apply to all five elements of a service connection
claim: veteran status, existence of a disability, a connection
between the veteran's service and the disability, degree of
disability, and effective date of the disability. Dingess v.
Nicholson, 19 Vet. App. 473 (2006).
In light of the Board's favorable decision on the Veteran's
service-connection claim, the Board finds that all notification
and development action needed to fairly adjudicate this appeal
has been accomplished.
II. Pertinent Laws and Regulations
Service connection may be granted for disability resulting from
disease or injury incurred in or aggravated by service. 38
U.S.C.A. § 1131; 38 C.F.R. § 3.303. Service connection may be
granted for any disease diagnosed after discharge from service
when all the evidence, including that pertinent to service,
establishes that the disease was incurred in service. 38 C.F.R.
Service connection may be established on a secondary basis for a
disability which is proximately due to or the result of a
service-connected disease or injury; or, for any increase in
severity of a nonservice-connected disease or injury that is
proximately due to or the result of a service-connected disease
or injury, and not due to the natural progression of the
nonservice-connected disease. 38 C.F.R. § 3.310(a),(b); Allen v.
Brown, 7 Vet. App. 439, 448 (1995).
When, after careful consideration of all procurable and assembled
data, a reasonable doubt arises regarding service origin, the
degree of disability, or any other point, such doubt will be
resolved in favor of the claimant. Reasonable doubt is one that
exists because an approximate balance of positive and negative
evidence which does satisfactorily prove or disprove the claim.
It is a substantial doubt and one within the range of probability
as distinguished from pure speculation or remote possibility. 38
C.F.R. § 3.102 (2009). See also 38 U.S.C.A. § 5107(b); Gilbert
v. Derwinski, 1 Vet. App. 49, 53-56 (1990).
The Board finds, after reviewing all of the evidence of record
and assessing the weight of the evidence, that the evidence is in
relative equipoise as to whether an eye disability, identified as
cataracts, is proximately due to or the result of the Veteran's
service-connected diabetes mellitus.
Service treatment records are void of any complaints of or
treatment for any eye disabilities.
A May 2004 private treatment record shows that the Veteran was
having visual complications which were directly due to his
diabetes. The physician remarked that the Veteran was having
early cataract formation in both eyes.
A July 2004 VA examination shows that Veteran reported a history
of diabetes for the past eighteen years for which he has been on
oral medications. He denied any past history of ocular injuries,
disease, or surgeries. He had no visual symptoms and denied
using eye treatment.
Upon physical examination, visual acuity without correction at
far measured OD 20/25, and OS 20/25-2. The best correctable
visual acuity at far OD and OS both read 20/20. The best
correctable vision at near OD and OS both read J1+1, which is a
20/20 equivalent. The examiner noted that the visual fields were
full to finger count in each quadrant. Motility was full. There
were no significant horizontal or vertical deviations. Pupils
were 3 mm, round, regular. No afferent papillary defect was
noted. The external examination of the eyes, lids and lashes was
normal. The slit-lamp examination of the eyes, cornea,
conjunctiva, sclera, iris, and anterior chambers was normal. The
intraocular pressure showed 13 mmHg by applanation and the eyes
at 8:22 a.m.
On dilated examination, the lenses showed trace nuclear
sclerosis, 1+ AV nicking, no background diabetic retinopathy.
Vitreous is normal. C/D ratio right eye is 0.2 in both eyes.
Maculae were normal. Peripheral retina with binocular indirect
showed no evidence of breaks or detachments. The diagnosis was
of diabetes mellitus type 2 without ophthalmic signs, and
incipient cataract, not related to diabetes.
A December 2005 VA examination report shows that the Veteran
reported having diabetes mellitus for ten years which required
oral medication. The Veteran denied any history of ocular
injuries, diseases, or surgeries. He has no eye pain or visual
symptoms. He denied using any eye treatment. Upon physical
examination, the confrontation fields were full to finger count
in each quadrant. Motility was full. There was no significant
horizontal or vertical deviation. Pupils were 2mm, equal, round,
regular, and responded to light accommodation. There was no
afferent papillary defect. External examination of both eyes
showed that the lids and lashes were normal. Slit-lamp
examination showed that the conjunctivae, sclerea, and cornea
were all normal. The iris was normal with no evidence of
neovascularization in either eye. Anterior chambers were deep
and clear in both eyes. Upon dilated examination, lenses showed
trace nuclear sclerosis. Vitreous was clear. Posterior pole
showed no signs of background diabetic retinopathy. The Veteran
was diagnosed with diabetes mellitus, type 2, without ophthalmic
signs and incipient cataracts, bilateral, not related to
diabetes. The examiner commented that there was no diabetic-
caused visual impairment or disability.
A March 2007 VA examination report shows that the Veteran had no
subjective eye complaints. The Veteran reported that he was
diagnosed with diabetes in 1985. The Veteran denied any
knowledge of family history of eye disease. He also denied any
personal history of eye injuries, infections, disease, or
Upon physical examination, there was pinguecula on the temporal
and nasal aspect of both eyes. All other anterior segment
findings were nominal for each eye. The right fundus had no
apparent disease. The left fundus had no diabetic retinopathy
but had a small area of lattice degeneration in the inferior and
superior far periphery. The cup/disk ratio of each optic nerve
head was .3/.3, with each neuroretinal rim intact. The
assessments were of no diabetic retinopathy in the eyes, and
peripheral marginal degeneration (not caused by his diabetes).
The Veteran has contended that his current cataracts are a result
of his service-connected diabetes mellitus. In this context, the
May 2004 private treatment record unequivocally relates the
Veteran's cataracts to his service connected diabetes.
Subsequently, the Veteran was examined by the VA in July 2004.
The examiner diagnosed the Veteran, in part, with incipient
cataracts, not related to diabetes. However, the VA examiner did
not provide any rationale for his opinion; and although the
examiner stated in his report that he reviewed the claims file
and all medical records, the examiner made no mention of the May
2004 private opinion in his examination report.
The Veteran was examined, by the same VA examiner, in December
2005. The examination report was almost identical to the July
2004 report. The examiner stated that the claims file was
available for review but no mention was made of the May 2004
private opinion report. According to the VA examiner in December
2005, no medical opinion was requested.
The March 2007 VA examiner assessed the Veteran has having no
diabetic retinopathy for in either the left or right eye and
found that peripheral marginal degeneration, left eye (not caused
by his diabetes). The Board notes that this opinion does not
mention cataracts or their possible relationship to the Veteran's
diabetes. Thus, while the opinion is probative as to whether
retinopathy is related to the Veteran's service connected
diabetes, it is of no probative value as to the issue of whether
the Veteran's cataracts are related to his service connected
As aptly noted by the record, the evidence is in relative
equipoise as to whether the Veteran's cataracts are related to
his service connected diabetes. In support of the Veteran's
claim is the May 2004 private report. Weighing against the
Veteran's claim are the VA examination reports (of July 2004 and
December 2005), with the March 2007 VA report providing no
opinion at all regarding a nexus between the diabetes mellitus
The Board is charged with the duty to assess the credibility and
weight given to evidence. Wensch v. Principi, 15 Vet. App. 362,
367 (2001); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991).
Indeed, the Court has declared that in adjudicating a claim, the
Board has the responsibility to do so. Bryan v. West, 13 Vet.
App. 482, 488-89 (2000); Wilson v.Derwinski, 2 Vet. App. 614, 618
(1992). In this case the Board has assessed the weight to be
given to each piece of probative evidence and has determined that
the positive and negative evidence is of equal proportion to put
the claim in relative equipoise.
As such, after resolving all reasonable doubt in favor of the
Veteran, the Board finds that service connection for a disability
of the eyes, identified as cataracts, as secondary to service-
connected diabetes mellitus, is warranted.
Entitlement to service connection for a disability of the eyes,
identified as cataracts, as secondary to service connected
diabetes mellitus, is granted.
DEBORAH W. SINGLETON
Veterans Law Judge, Board of Veterans' Appeals
Department of Veterans Affairs
Thanks for the reply, very helpful.
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