CATARACT EXTRACTION

R. FEINBERG · 2026 · Case ID: 26001197

MIXED

Summary

The Veteran, an Air Force Veteran who served from November 1970 to December 1974, appeals the denial of service connection for bilateral cataracts and the grant of TDIU. The Veteran contended that his cataracts were incurred during service or were secondary to his service-connected diabetes mellitus, type 2. However, the Board found the evidence weighed against service connection for cataracts, noting no in-service complaints or treatment, normal eye findings at separation, and subsequent cataract surgery in 2011. VA medical opinions indicated the cataracts were age-related and less likely than not caused by or related to diabetes, with no established baseline for aggravation. The Board denied service connection for cataracts. Regarding TDIU, the Veteran claimed his service-connected disabilities, including PTSD (rated 70%), diabetes, and bilateral neuropathy, rendered him unemployable. The Board reviewed multiple VA examinations and the Veteran's testimony, noting his PTSD and neuropathy significantly impacted his ability to work. The Board found the Veteran met the schedular requirements for TDIU effective August 10, 2022, granting TDIU based on the combined impact of his service-connected conditions and resolving doubt in his favor.

Rationale

No in-service complaints, treatment, or diagnosis for eye condition.; Separation examination showed normal eyes.; VA opinions found cataracts age-related and less likely than not caused by or related to diabetes.; No established baseline for aggravation due to diabetes.; No probative evidence of etiological link to service or diabetes.

Service Branch

AIR FORCE

Special Benefit

TDIU

Docket No.

19-12 920

Full Decision Text

Citation Nr: 26001197
Decision Date: 01/29/26 Archive Date: 01/29/26

DOCKET NO. 19-12 920
DATE: January 29, 2026

ORDER

Entitlement to service connection for diabetic cataracts is denied.

Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is granted.

FINDINGS OF FACT

1. The Veteran's bilateral cataracts did not have its onset during active-duty service, is not otherwise related to active duty service, and was not caused or shown by a medically established baseline that it was caused or aggravated by service-connected diabetes mellitus, type II.

2. The Veteran's service-connected disabilities preclude substantially gainful employment consistent with his educational background and occupational experiences from August 10, 2022.

CONCLUSIONS OF LAW

1. The criteria for service connection for diabetic cataracts, to include as secondary to diabetes, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

2. The criteria for TDIU are met from August 10, 2022. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Air Force from November 1970 to December 1974.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in May 2023, and a remand was issued for further development. The matter has now come back before the Board.

1. Diabetic Cataracts

The Veteran contends that his bilateral cataracts were incurred in, aggravated by, or otherwise attributable to, active-duty service. Alternatively, the Veteran contends that his bilateral cataracts were proximately caused by, or aggravated by, service-connected diabetes mellitus, type 2.

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection is also warranted for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(b).

When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a Veteran prevailing in either event, or whether the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

The Board has carefully reviewed the evidence of record and finds that the evidence is against the grant of service connection for bilateral cataracts on a direct or as secondary to service-connected type II diabetes mellitus.

The Veteran contends that his cataracts were caused or aggravated by his service-connected diabetes mellitus.

The Veteran's service treatment records (STRs) have been reviewed and are associated with the claims file. The Veteran's STRs are silent for a diagnosis, symptoms, or treatment of any eye condition. Upon separation in October 1974 from active duty, the Veteran's eyes were normal. See STRs.

The medical treatment records note cataract surgery in 2011. See July 2011 VA Mental Health Outpatient Note. The medical treatment records note that the left eye cataract
of service connection for bilateral cataracts on a direct or as secondary to service-connected type II diabetes mellitus.

The Veteran contends that his cataracts were caused or aggravated by his service-connected diabetes mellitus.

The medical treatment records note cataract surgery in 2011. See July 2011 VA Mental Health Outpatient Note. The medical treatment records note that the left eye cataract was the only symptomatic eye in 2011. See February 2011 VA Addendum Note.

In a June 2014 VA examination for diabetes, the examiner noted that the Veteran had unrelated cataracts and underwent surgery on the left eye and pending surgery on the right eye. See June 2014 VA Diabetes Mellitus Disability Benefits Questionnaire (DBQ).

In a June 2024 VA examination for eye conditions, the examiner noted diagnosis of cataract with a date of diagnosis in August 2010. The examiner noted bilateral preoperative cataract condition. The examiner noted that there is no decrease in visual acuity or other visual impairment. The examiner opined that the Veteran's cataract condition was less likely than not caused by or a result of diabetes. The examiner stated that after 40 years old, the proteins in the lens of your eye naturally start to break down. Most cataracts happen because of these natural changes. See June 2024 VA Eye Conditions DBQ.

In an August 2024 VA medical opinion, the examiner opined that the Veteran's cataracts were less likely than not proximately due to or the result of the Veteran's service-connected conditions. The examiner noted that, based on the available medical evidence, the examiner is unable to determine the etiology of the cataract condition without resorting to speculation. The treatment records note the Veteran had bilateral cataract surgery and it is impossible to assess the type of cataract to determine the etiology. Additionally, the course of the claimed eye condition is not fully documented. See August 2024 VA Medical Opinion DBQ.

In a September 2024 VA medical opinion, the examiner, after reviewing the conflicting medical evidence, stated that the June 2024 VA examination list cataracts. The examiner stated that this is incorrect. The cataracts were surgically removed and pseudophakic implants are present as evidenced by the July 2022 eye examination. The examiner opined that the medical records support that the Veteran has the diagnosis of pseudophakia which is the presence of an artificial lens in the eye. This was placed when the cataract was surgically removed. It is likely that the Veteran's cataract is proximately due to aging. See September 2024 VA Medical Opinion DBQ.

The evidence weighs against finding that the Veteran's diagnosed cataracts were incurred during the Veteran's active service or are otherwise related to service as there is no probative evidence of record indicating an etiological link between the Veteran's cataract diagnosis or current pseudophakia diagnosis and active service.

The Board notes that secondary service connection on the basis of aggravation may only be granted when there is an increase in severity of the nonservice-connected disability beyond a medically established baseline due to the service-connected disability. VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established. 38 C.F.R. § 3.310(b).

This baseline is to be established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. Id. The rating activity is to determine the baseline and current levels of severity under the Schedule for Rating Disabilities (38 C.F.R. part 4) and determine the extent of aggravation by deducting the baseline level of severity, as well as any increase in severity due to the natural progress of the disease, from the current level. Id.

The Board finds the other evidence of record to be consistent with the above. Although the Veteran may sincerely believe that his current cataracts, or now diagnosed pseudophakia, are related to symptomatology in active service or related to service-connected diabetes mellitus type 2, there is no indication that he has the training or experience required to render a competent opinion
or injury. Id. The rating activity is to determine the baseline and current levels of severity under the Schedule for Rating Disabilities (38 C.F.R. part 4) and determine the extent of aggravation by deducting the baseline level of severity, as well as any increase in severity due to the natural progress of the disease, from the current level. Id.

Absent competent, credible, and probative evidence of a nexus between the Veteran's service and his bilateral cataracts or pseudophakia, the Board finds that his bilateral cataracts, to include pseudophakia, were not incurred in-service and it is not otherwise related to active service; because there were no complaints, treatment or diagnosis for any eye condition while the Veteran was in-service and he denied ever having any eye trouble during his separation examination.

In terms of secondary service connection, the Board finds that weight of competent evidence is that the Veteran's bilateral cataracts, to include pseudophakia, are not due to or aggravated by the Veteran's service-connected diabetes because there is no medical evidence of record corroborating that the Veteran's diabetes mellitus was the cause of his cataracts or that his diabetes worsened his cataracts in the sense that his visual acuity was made worse by the influence of diabetes. The VA medical opinions indicated that the Veteran's cataracts were age related and did not have the specific clinical appearance of sudden onset diabetic cataracts. The examiner found that at most, the impact of diabetes may have influenced an earlier onset (age 60 being on the earlier side of normal) but the baseline could not be established. The evidence did not show that a functional disability of degraded vision was made worse by diabetes.

The Board also finds that without establishing a baseline severity, his bilateral cataracts, to include pseudophakia, were not caused by or aggravated by the Veteran's service-connected diabetes mellitus, type II, as the Veteran has not offered competent and probative medical evidence in support of his claim and the VA examiners were also unable to determine the baseline severity. See 38 U.S.C. § 5107(a).

The evidence is against the claim of service connection for bilateral cataracts, to include pseudophakia, as secondary to service-connected diabetes, the benefit-of-the-doubt doctrine is not for application, and the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

2. TDIU

The Veteran seeks TDIU. He contends his service-connected disabilities render him unemployable.

TDIU may be assigned, where the schedular rating is less than total, where a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16(a). To qualify for schedular consideration of TDIU, if there is only one such disability, this disability shall be ratable at 60 percent or more, and, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. Id.

For the purposes of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) Disabilities of one or both upper extremities, one or both lower extremities, including the bilateral factor, if applicable; (2) disabilities resulting from common etiology or a single accident; (3) disabilities affecting a single body system, e.g., orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric; (4) multiple injuries incurred in action; or (5) multiple disabilities incurred as a prisoner of war. 38 C.F.R. § 4.16(a); see Moody v. Wilkie, 30 Vet. App. 329, 339 (2018) (combining disabilities as "one disability" to meet the rating threshold of § 4.16(a) requires the use of the combined rating table).

The phrase "unable to secure and follow a substantially gainful occupation" contains both economic and noneconomic components. See Ray v
iology or a single accident; (3) disabilities affecting a single body system, e.g., orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric; (4) multiple injuries incurred in action; or (5) multiple disabilities incurred as a prisoner of war. 38 C.F.R. § 4.16(a); see Moody v. Wilkie, 30 Vet. App. 329, 339 (2018) (combining disabilities as "one disability" to meet the rating threshold of § 4.16(a) requires the use of the combined rating table).

The phrase "unable to secure and follow a substantially gainful occupation" contains both economic and noneconomic components. See Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). The economic component refers to an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. Id. The noneconomic component requires a determination as to a veteran's ability to secure and follow such employment. Id. Attention should be given to the veteran's history, education, skills, and training; whether the veteran has the physical ability (both exertional and nonexertional) to perform the types of activities required by the occupation at issue (e.g., lifting, bending, sitting, standing, walking, climbing, as well as auditory and visual limitations); and whether the veteran has the mental ability to perform the activities required by the occupation at issue (e.g., memory, concentration, ability to adapt to change, handle work place stress, get along with coworkers, and demonstrate reliability and productivity). Id.

An award of TDIU is an individualized determination, specific to a veteran's particular circumstances, e.g., their history, education, skills, and training. See Todd v. McDonald, 27 Vet. App. 79, 85 (2014). It does not require a showing of 100 percent unemployability. Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001). The ultimate question is whether they are capable of performing the physical and mental acts required by employment, not whether they can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993).

During this appeal, the Veteran has the following disabilities that are service connected: posttraumatic stress disorder (PTSD) 50 percent effective May 31, 2013 and 70 percent effective October 20, 2023; diabetes mellitus rated 20 percent August 10, 2022; bilateral lower extremity diabetic neuropathy of the sciatic nerve each rated at 10 percent effective August 10, 2022; bilateral lower extremity diabetic neuropathy of the femoral nerve each rated 10 percent effective August 10, 2022; and bilateral upper extremities diabetic neuropathy each rated noncompensable effective November 29, 2022 to June 1, 2025.

Based on the forgoing, the Veteran has at least one disability rated at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more effective August 10, 2022. Accordingly, the Board may consider the claim for TDIU on a schedular basis. 38 C.F.R. § 4.16(a).

For the reasons that follow, the Board finds that TDIU is warranted effective August 10, 2022.

The Veteran's ability to secure and follow a substantially gainful occupation is impacted by the physical effects of his service-connected PTSD, diabetes, and neuropathy of the bilateral upper and lower extremities.

The Board notes the November 2025 rating decision issued under AMA, granted entitlement to TDIU effective March 20, 2025, the date the claim for TDIU was received. The Board notes the rating decision determined that the Veteran was entitled to TDIU effective the date the claim was received. The RO continued to state that because the claim was received within one year of the VA's notification for the increased evaluation for service-connected PTSD, and because other evidence of records showed that you were not employed at that time, you meet the requirements for granted TDIU effective June 26, 2019. 38 C.F.R. § 3.400(o)(2).

Here, the claim of TDIU has been raised as to the claim filed in 2014 and rating decision on appeal from April 2014. The Board finds that entitlement to service connection for TDIU is granted effective August 10, 2022, the date which the Veteran met sched
U effective the date the claim was received. The RO continued to state that because the claim was received within one year of the VA's notification for the increased evaluation for service-connected PTSD, and because other evidence of records showed that you were not employed at that time, you meet the requirements for granted TDIU effective June 26, 2019. 38 C.F.R. § 3.400(o)(2).

The VA medical treatment records notes the Veteran appeared fatigued and depressed. The Veteran reported suicidal ideation without a plan. The Veteran also reported attention problems. See November 2018 VA Mental Health Outpatient Note.

In July 2018, the Veteran underwent a VA examination for PTSD. Here, the Veteran reported that he reduced his workload and closed his business due to emotional and behavioral problems increasing and interfering with his work safety and progress. Specifically, the Veteran reported he was experiencing flashbacks daily to the point that he could not work. The examiner noted suicidal ideation with no plan. See July 2018 VA Review PTSD DBQ.

In a May 2024 VA examination for diabetes mellitus, the examiner found that the Veteran's condition impacts his ability to work. The examiner noted the Veteran suffers from constant peripheral neuropathy in bilateral lower extremities which progressed to the point that he had to quit his job. See May 2024 VA Diabetes Mellitus DBQ.

In a September 2024 VA examination for PTSD, the examiner found the Veteran's PTSD amounted to occupational and social impairment with deficiencies in most areas.

In an October 2024 VA examination for diabetic sensory-motor peripheral neuropathy. The examiner noted that the Veteran's conditions impacted his ability to work. Specifically, the examiner noted that he has difficulty walking and feeling things with his feet. See October 2024 VA Diabetic Sensory DBQ.

The Veteran testified in a November 2022 Board hearing. It was reported that the Veteran's trauma triggers him daily affecting is ability to maintain gainful employment. At this time, the Veteran did own his own business but was unable to work his construction business for years due to his PTSD and diabetes. The Veteran reported that his business does not bring in any income and only survives on rental income and makes less than the state poverty level per year. See November 2022 Hearing Transcript.

In a claim for TDIU received in July 2024, the Veteran reported that he last worked fulltime in 2013. The Veteran reported that he worked in 2022 making $19,000 for the year, 2023 he made $14,000, and in 2024 made $5,000 for the year. In an April 2014 claim for TDIU, the Veteran reported his disabilities affected his ability to work as of 2014 and was self-employed.

The record evidence shows that the Veteran has reported consistently that he was self-employed doing manual labor and became too disabled to work as a result of his service-connected disabilities. For example, the Veteran's PTSD worsened which the Veteran reported that he could not work with others or interact with others. The Veteran's diabetic neuropathy made it difficult to perform his job duties. These disabilities affected his full-time employment and became too disabled to work.

Based on the foregoing, and after resolving all reasonable doubt in favor of the Veteran, the Board finds that a TDIU is warranted as the evidence demonstrates that the Veteran meets the requirements of 4.16(a) and is unable to secure or maintain substantially gainful employment due to his service-connected disabilities. Therefore, entitlement to a TDIU is granted. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16.

R. FEINBERG

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Glaeser, Jennifer

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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