CATARACT EXTRACTION

GREGORY DEEMER · 2025 · Case ID: 25014697

DENIED

Summary

The Veteran, an Army Veteran who served from November 1968 to October 1970, appeals the denial of service connection for bilateral cataracts. The Veteran claims the cataracts are secondary to service-connected hypertension, or related to in-service exposure to tactical herbicides and welding fumes. The Board found that the Veteran has a current disability (bilateral pseudophakia post-cataract surgery) and is service-connected for several conditions, including hypertension and PTSD. However, the Board denied service connection for cataracts. The August 2025 VA examiner opined that the cataracts were not secondary to hypertension, as the specific type of cataracts the Veteran developed are not typically associated with hypertension. The examiner also found the cataracts were not aggravated by hypertension beyond natural progression. Regarding direct service connection, the Board noted no in-service diagnosis of cataracts. The VA examiner in August 2017 opined that cataracts were less likely than not caused by welding, citing lack of research linking welding to accelerated cataract formation. A May 2025 VA examiner similarly opined that cataracts were less likely than not caused by tactical herbicide exposure, as there is no research indicating such a link. The Board found these opinions well-reasoned and assigned them significant probative weight. The Veteran's own assertions were considered less probative than the medical evidence. The Board acknowledged the doctrine of reasonable doubt but found the evidence weighed against the claim, thus not applying the doctrine.

Rationale

No medical nexus for secondary connection to hypertension; Cataracts not type associated with hypertension; No evidence of in-service diagnosis or aggravation; No nexus for herbicide or welding exposure

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

18-40 318

Full Decision Text

Citation Nr: 25014697
Decision Date: 12/09/25 Archive Date: 12/09/25

DOCKET NO. 18-40 318
DATE: December 9, 2025

ORDER

Entitlement to service connection for cataracts is denied.

FINDING OF FACT

The Veteran's cataracts are not secondary to service-connected hypertension, and are not otherwise related to an in-service injury or disease.

CONCLUSION OF LAW

The criteria for entitlement to service connection for cataracts due to service or service-connected hypertension were not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from November 1968 until his honorable discharge in October 1970. See October 1970 DD Form 214 (Certificate of Release or Discharge from Active Duty). The Veteran's Military Occupational Specialty (MOS) was 61C20 (Marine Engineer) and during his service, he was awarded the National Defense Service Medal, Vietnam Service Medal, and Vietnam Campaign Medal. Id.

This appeal has been advanced on the Board's docket pursuant to 38 U.S.C. § 7107(a)(2); 38 C.F.R. § 20.900(c).

The Veteran had additional service in the United States Army Reserve and Army National Guard with period(s) of inactive duty for training and active duty for training until his retirement.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a December 2013 rating decision by the Regional Office of the United States Department of Veterans Affairs (VA).

In September 2022, the Veteran testified at a Board hearing before the undersigned Acting Veterans Law Judge. A transcript of the hearing has been associated with the record on appeal. During the hearing, the undersigned held the record open for 60 days to allow for the submission of additional evidence.

In March 2023 and October 2024, the Board remanded the case to the Regional Office for further development. Specifically, the most recent Board remand directed the Regional Office to (1) Ask the Veteran to complete a VA Form 21-4142 for any private provider(s) that have diagnosed and/or treated the Veteran for cataracts, that are not already of record; (2) obtain the Veteran's VA treatment records for any period not already of record; (3) schedule the Veteran for a VA examination for his bilateral cataracts, noting that the examiner should consider and discuss the Stanford Medicine webpage regarding cataract risk factors that included high blood pressure. In response, in November 2024, the Regional Office sent the Veteran a subsequent development letter, obtained outstanding VA treatment records, and obtained a VA examination with medical opinions in August 2025.

Qualifying Service

Active duty for training includes full-time duty with the Reserves, or the National Guard of any State under sections 316, 502, 503, 504, or 505 of title 32 (32 U.S.C. §§ 316, 502, 503, 504, or 505), or the prior corresponding provisions of law. See 38 U.S.C. § 101(22)(b) and 38 U.S.C. §§ 101(22)(C); 38 C.F.R. § 3.6(c). Basically, this refers to the two weeks of annual training, which each Reservist or National Guardsman must perform each year. It can also refer to the Reservist's or National Guardsman's initial period of training.

Furthermore, 38 C.F.R. § 3.6(a) provides that any period of active military, naval, and air service, including active duty for training during which the individual was disabled or died from a disease or injury incurred or aggravated in the line of duty, and any period of inactive duty training during which the individual concerned was disabled or died from an injury (but not disease) incurred or aggravated in line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident, in which occurred during such training.

To establish status as a "veteran" for a period of active duty for training, a claimant must establish that he was disabled from disease or injury incurred or aggravated in the line of duty during that period of active duty for training. 38 C.F.R. § 3.1(a), (d); Paulson v. Brown, 7 Vet. App. 466, 470 (1995). The burden to establish "veter
inactive duty training during which the individual concerned was disabled or died from an injury (but not disease) incurred or aggravated in line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident, in which occurred during such training.

To establish status as a "veteran" for a period of active duty for training, a claimant must establish that he was disabled from disease or injury incurred or aggravated in the line of duty during that period of active duty for training. 38 C.F.R. § 3.1(a), (d); Paulson v. Brown, 7 Vet. App. 466, 470 (1995). The burden to establish "veteran" status for a claim based on a period of active duty for training is on the appellant. Donnellan v. Shinseki, 24 Vet. App. 167, 171-75 (2010). The fact that a claimant has established status as a veteran for other periods of service does not obviate the need to establish that he is also a veteran for purposes of the period of active duty for training where the claim for benefits is based on that period of active duty for training. Mercado-Martinez v. West, 11 Vet. App. 415, 419 (1998).

When a claim for service connection is based on a period of active duty for training, there must be some evidence that the appellant became disabled as a result of a disease or injury incurred or aggravated in the line of duty during the period of active duty for training. Smith v. Shinseki, 24 Vet. App. 40, 47 (2010). In the absence of such evidence, the period of active duty for training would not qualify as "active military, naval, or air service," and the appellant would not qualify as a "veteran" by virtue of active duty for training service alone. Id. See also 38 U.S.C. § 101(2), (24); 38 C.F.R. §§ 3.1(d), 3.6(c).

Inactive duty for training includes service with the Reserve (other than full-time duty) that usually indicates weekend drills or training. 38 U.S.C. § 101(23)(A), 38 C.F.R. § 3.6(d). Inactive duty training also includes service in the National Guard of any State under sections 316, 502, 503, 504, or 505 of title 32 (32 U.S.C. §§ 316, 502, 503, 504, or 505), or the prior corresponding provisions of law (including drill weekends under 32 U.S.C. § 502(a)). See 38 U.S.C. § 101 (23); 38 C.F.R. § 3.6(d).

When a claim for service connection is based on a period of inactive duty for training, there must be some evidence that the appellant became disabled as a result of an injury (not disease) incurred or aggravated in the line of duty during the period of inactive duty for training. Smith v. Shinseki, 24 Vet. App. 40, 47 (2010). In the absence of such evidence, the period of inactive duty for training would not qualify as "active military, naval, or air service," and the appellant would not qualify as a "veteran" by virtue of inactive duty for training service alone. Id. See also 38 U.S.C. § 101(2), (24); 38 C.F.R. §§ 3.1(d), 3.6(d).

In turn, this means that a person is not a veteran for the purposes of applying certain presumptions, including presumptive service connection for chronic diseases, as well as the presumption of soundness at service entrance, unless he is service-connected for disease or injury incurred or aggravated during active duty for training or service-connected for injury, but not disease, incurred or aggravated during inactive duty for training.

VA's Office of General Counsel has defined "injury" as harm resulting from an external trauma, while "disease" is defined as some type of internal infection or degenerative process. VAOPGCPREC 04-2002 (May 14, 2002).

National Guard duty is also distinguishable from other Reserve service in that a member of the National Guard may be called to duty by the governor of his or her state. "[M]embers of the National Guard only serve the Federal military when they are formally called into the military service of the United States [and a]t all other times, National Guard members serve solely as members of the State militia under the command of a state governor." Allen v. Nicholson, 21 Vet. App. 54, 57 (2007). Therefore, to have basic eligibility as a veteran based on a period of duty as a member of a state National Guard, a guardsman must have been ordered into Federal service by the President of the United States under 38 U.S.C. §§ 316, 502, 503, 504, or 505. Hence, for the appellant's service in the National Guard, only periods of Federalized service are qualifying service for the purpose of VA compensation benefits.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service - the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

In addition, service connection for certain chronic diseases may be established on a presumptive basis by showing that the condition manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a); Fountain v. McDonald, 27 Vet. App. 258, 271-72 (2015). Although the disease need not be diagnosed within the presumptive period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a).

Additionally, for certain chronic diseases with potential onset during service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of the disability (but only that degree) over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b) (2017); Allen v. Brown, 8 Vet. App. 374 (1995).

Recently, in Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023), the Federal Circuit Court of Appeals held 38 U.S.C. § 1110 employs only "but-for" causation in direct and secondary service connection claims. Therefore, a service-connected disability need only be a contributing cause, not the
disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of the disability (but only that degree) over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b) (2017); Allen v. Brown, 8 Vet. App. 374 (1995).

Entitlement to service connection for bilateral cataracts, to include as secondary to service-connected hypertension, is denied.

The Veteran asserts that his bilateral cataracts are associated with his service-connected hypertension and/or related to an in-service exposure to tactical herbicide agent(s) and/or MOS-related welding. See September 2022 Hearing Transcript, see also July 2014 VA Form 21-4138; August 2017 VA 21-2507a.

First, the Board finds that there is evidence of a current disability. See Wallin, 11 Vet. App. 509, 512 (1998); see also Allen, supra, see Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran was afforded a VA examination in August 2025. The August 2025 VA examiner diagnosed the Veteran with bilateral pseudophakia (status post cataract surgery with replacement lens). See August 2025 VA Examination, Section I.

Second, the Board finds that there is evidence of a service-connected disability. See Wallin, 11 Vet. App. 509, 512 (1998); see also Allen, supra. The Veteran is currently service-connected for chronic obstructive pulmonary disease (COPD) with obstructive sleep apnea, posttraumatic stress disorder (PTSD) with depressive and anxious features, prostate cancer, hypertension, erectile dysfunction, and scar(s) [status post prostatectomy].

Third, the Board finds that there is not medical nexus evidence establishing a connection between the Veteran's service-connected disability and the current disability. The August 2025 VA examiner opined that the Veteran's bilateral cataracts are proximately due to or the result of the Veteran's service-connected hypertension because cataracts the haziness of the internal lens of the eye, which naturally occurs in the 6th decade of life, typically requiring surgery in the 7th decade of life; for which is reflected in the Veteran's history. Furthermore, although the Stanford article noted hypertension as one factor that increases the risk of cataract formation (posterior sub-capsule type), the Veteran was diagnosed with posterior cortical cataract of the left eye and nuclear cataract of the right eye. Because the Veteran developed cataracts unassociated with hypertension (posterior sub-capsule type), the Veteran's cataracts are not secondary to his service-connected hypertension. Finally, the August 2025 VA examiner also opined that the Veteran's bilateral cataracts were not aggravated beyond natural progression by his service-connected hypertension because the Veteran's bilateral cataracts were not the type associated with hypertension (sub-capsule type). Accordingly, entitlement to service connection on a secondary basis for bilateral cataracts is denied.

As to direct service connection under 38 C.F.R. § 3.303, the record on appeal does not show the Veteran being diagnosed with bilateral cataracts while on active duty. See 38 C.F.R. § 3.303(a).

The Board finds that there was an in-service event, injury or disease. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The evidence of record reflects that the Veteran was exposed to tactical herbicide agent(s) and additional toxic exposure(s) due to welding fume(s).

Third, the Board finds that the evidence of record does not support a finding that the Veteran's bilateral cataracts are related to his active service. The August 2017 VA examiner opined that the Veteran's cataract are less likely than not incurred in or caused by welding due to the Veteran's MOS because although welding is well known to cause corneal burns, it is not a known to cause cataracts to form more quickly and the Veteran's cataracts are within normal bounds for his age. The May 2025 VA examiner opined that the Veteran's cataracts are less likely than not incurred in or caused by the claimed in-service injury, event, or illness because there is no research to indicate tactical herbicide exposure causing cataracts and there is no evidence that Veterans exposed to tactical herbicide agent(s) have developed cataracts outside of the normal limits of age onset. Accordingly, entitlement to service connection for bilateral cataracts is denied.

Taken together, the Board finds that the August 2017, April 2023, and May 2025 VA medical opinions are consistent, well-reasoned, and based on accurate medical histories. They reflect familiarity with the Veteran's relevant medical history and are supported by clinical data and medical literature. As such, the Board assigns them significant probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

The evidence in favor of the Veteran's claim includes his statements and testimony. Although the Veteran believes his cataracts are related to service or hypertension, he is not competent to provide a nexus opinion on this medically complex issue. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In this regard, the Board finds the competent and credible medical evidence more probative.

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In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the evidence persuasively weighs against the Veteran's claim, the doctrine is not for application. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Gregory Deemer

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board R. P. Skinner III

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.

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