diabetes- cataracts

Discussion in 'General Medical' started by boogalee, Feb 26, 2011.

  1. boogalee

    boogalee New Member

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    Can cataracts be compensated in relation to secondary to diabetes?
  2. CEDAR FALLS

    CEDAR FALLS Member

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    I looked at appeals here you can look and find symtoms that fit your claim
    these appeals have all been judged on GOOD LUCK

    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


    THE ISSUE

    Entitlement to service connection for a disability of the eyes,
    to include cataracts, as secondary to the service connected
    diabetes mellitus.


    ATTORNEY FOR THE BOARD

    Katie K. Molter


    INTRODUCTION

    The Veteran served on active duty from November 1963 to November
    1966.

    This appeal before the Board of Veterans' Appeals (Board) arises
    from a July 2004 rating decision of the RO which denied the
    Veteran's claim.

    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
    appeal.


    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,
    3.310(a) (2009).


    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.
    § 3.303(d).

    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).




    III. Analysis

    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
    surgeries.

    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
    diabetes.

    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
    and cataracts.

    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.


    ORDER

    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
  3. boogalee

    boogalee New Member

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    Thanks for the reply, very helpful.
  4. paulpjack

    paulpjack New Member

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