Back to BVA DecisionsGRANTEDSpecial Benefit NO SPECIAL BENEFIT Docket No. 17-30 185
CATARACT EXTRACTION
MICHAEL J. SKALTSOUNIS · 2026 · Case ID: 26001811
Summary
The Veteran served on active duty from April 1968 to March 1971. This case comes before the Board of Veterans' Appeals (Board) on appeal from a January 2014 rating decision, following a September 2025 remand for further development. The Veteran sought service connection for cataracts and diabetic retinopathy, claiming they were secondary to his service-connected diabetes mellitus type 2. The Board granted service connection for both conditions. For cataracts, the Board found that while a VA examiner opined they were age-related, the examiner also noted diabetes can accelerate cataract formation. Applying the benefit of the doubt, the Board found service connection warranted. For diabetic retinopathy, the Board noted conflicting evidence, with some earlier records showing no retinopathy and later records from 2022 and 2023 diagnosing it. A VA examiner's opinion questioning the diagnosis based on the training status of the reporting physicians was found to have little probative value due to a lack of reasoned medical explanation. The Board found the evidence in approximate balance and, affording the Veteran the benefit of the doubt, found that he has the diagnosed disorder, which is by definition a complication of diabetes mellitus, thus granting secondary service connection.
Rationale
Current diagnosis of bilateral cataracts; Service-connected diabetes mellitus type 2; Medical opinion notes diabetes accelerates age-related cataracts; Benefit of the doubt applied
Full Decision Text
Citation Nr: 26001811 Decision Date: 02/10/26 Archive Date: 02/10/26 DOCKET NO. 17-30 185 DATE: February 10, 2026 ORDER Entitlement to service connection for cataracts, to include as secondary to diabetes mellitus type 2 is granted. Entitlement to service connection for diabetic retinopathy, to include as secondary to diabetes mellitus type 2 is granted. FINDINGS OF FACT 1. The Veteran's cataracts were caused or aggravated by service-connected diabetes mellitus type 2. 2. Affording the Veteran the benefit of the doubt, he has a current diagnosis of diabetic retinopathy. CONCLUSIONS OF LAW 1. The criteria for service connection for cataracts as secondary to diabetes mellitus type 2 have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for service connection for diabetic retinopathy as secondary to diabetes mellitus type 2 have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1968 to March 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2014 rating decision issued by the Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ). Most recently, as relevant here, the Veteran's claim for entitlement to service connection for his eye disabilities was remanded by the Board in a September 2025 decision for further development. In November 2025, the AOJ issued a supplemental statement of the case (SSOC) which denied entitlement to service connection for the Veteran's cataracts and diabetic retinopathy. The appeal is now returned to the Board for adjudication. As the instant decision grants entitlement to service connection for the above eye disabilities, no further discussion of remand compliance is necessary at this time. See Stegall v. West, 11 Vet. App. 268, 271 (1998). This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.800. 38 U.S.C. § 7107. Service Connection Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 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). Service connection may also be granted on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury, or for additional disability resulting from the aggravation of a nonservice-connected disability by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). To establish entitlement to service connection on a secondary basis, there must be (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) medical evidence establishing a nexus between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509 (1998). When there is an approximate balance of positive and negative evidence as to any issue material to the determination of a matter, VA will resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). 1. Entitlement to service connection for cataracts The Veteran contends that his cataracts are due to his military service, to include conceded exposure to herbicide agents. In the alternative, he asserts that his cataracts are secondary to his service-connected diabetes mellitus, type 2. See June 2019 Appellate Brief. The Board notes that its analysis will material to the determination of a matter, VA will resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). 1. Entitlement to service connection for cataracts The Veteran contends that his cataracts are due to his military service, to include conceded exposure to herbicide agents. In the alternative, he asserts that his cataracts are secondary to his service-connected diabetes mellitus, type 2. See June 2019 Appellate Brief. The Board notes that its analysis will focus on the theory of secondary service connection, as the evidence supports the benefits sought by the Veteran under this theory only. As to the first element of secondary service connection, VA treatment records from August 2022 reflect the Veteran's diagnosis of bilateral cataracts, with the left eye worse than the right. The ophthalmologist planned a cataract extraction with intraocular lens insertion (CEIOL) for the left eye. See January 2023 CAPRI, ophthalmology consultation of August 4, 2022. A September 2023 VA eye conditions examination also notes the subsequent diagnoses of left eye pseudophakia and right eye age-related nuclear cataract. In light of the foregoing, the first element of secondary service connection is therefore met. Wallin, 11 Vet. App. at 509. A July 2022 Board decision granted service connection for the claimed primary disability of diabetes mellitus type 2. A December 2022 AOJ rating decision implemented the grant effective from March 29, 2013. As such, the second element of secondary service connection is met. Id. Given the above, the only question remaining is the issue of nexus. A VA medical opinion was obtained in September 2025, pursuant to a Board remand earlier that month. The examiner opined that the Veteran has age-related cataracts rather than diabetic cataracts (which tend to be found in young type 1 diabetics who have wide swings in blood sugars). In addition, the examiner noted that the configuration of the Veteran's cataracts is typical of age-related cataracts. The examiner provided a negative nexus opinion generally but also stated that diabetes mellitus is known to accelerate the formation of age-related cataracts. As noted above, secondary service connection is not solely predicated upon the finding that the claimed disability was caused by the service connected disability. Secondary service connection is also warranted when the claimed disability is aggravated by the service connected disability - as the VA examiner found here. Accordingly, affording the Veteran the benefit of all reasonable doubt, the Board finds that service connection is warranted for the Veteran's bilateral cataracts as secondary to his service-connected diabetes mellitus type 2. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310; Lynch, 21 F.4th at 776. 2. Entitlement to service connection for diabetic retinopathy The Veteran contends that he has diabetic retinopathy due to his service-connected diabetes mellitus type 2. The Board notes that there is conflicting evidence regarding the Veteran's diagnosis of diabetic retinopathy. VA treatment records from 2012-2023 reflect that the Veteran attended regular eye examinations to assess the impact of his diabetes mellitus, type 2 on the retina and other parts of the eye. Ophthalmic examinations from April 2014, October 2015, January 2017, and November 2020 found no diabetic retinopathy. During an August 2022 ophthalmology consultation, the Veteran reported that his left eye vision had become "foggy" over the past two months, he was having trouble with his distant and near vision, and he experienced fluctuations of vision in the mornings. The ophthalmologist examined the Veteran and diagnosed moderate bilateral non-proliferative diabetic retinopathy and bilateral cataracts, with the left eye worse than the right. An October 2022 ophthalmic consultation noted the same diagnoses. The physician informed the Veteran that his vision loss was at least partly due to a cataract, and that he anticipated that cataract surgery would result in an improvement in vision as there was not significant retinal and/or optic nerve pathology. The Veteran underwent left eye cataract surgery on October 27, 2022. In a November 2022 ophthalmologic consultation following the surgery, the clinician noted that a dilated fundus examination revealed the mornings. The ophthalmologist examined the Veteran and diagnosed moderate bilateral non-proliferative diabetic retinopathy and bilateral cataracts, with the left eye worse than the right. An October 2022 ophthalmic consultation noted the same diagnoses. The physician informed the Veteran that his vision loss was at least partly due to a cataract, and that he anticipated that cataract surgery would result in an improvement in vision as there was not significant retinal and/or optic nerve pathology. The Veteran underwent left eye cataract surgery on October 27, 2022. In a November 2022 ophthalmologic consultation following the surgery, the clinician noted that a dilated fundus examination revealed the presence of small, scattered microaneurysms and hemorrhages of the macula in both eyes and diffuse scattered hemorrhages in the central retinal area (posterior pole) in both eyes. The resident clinician further assessed moderate nonproliferative diabetic retinopathy in both eyes, currently stable. The chief of ophthalmology signed off on the report at a later date. See April 2023 CAPRI, ophthalmology note of November 29, 2022. In a May 2023 optometry consultation, the Veteran presented for a comprehensive eye exam for dilated diabetic examination and refraction. The optometry resident assessed moderate nonproliferative diabetic retinopathy in both eyes which was currently stable. The optometrist signed off on the report at the same time. See October 2023 CAPRI, optometry note of May 25, 2023. The November 2022 VA examiner stated that a review of the Veteran's records revealed no findings, signs, or symptoms to support a diagnosis of diabetic retinopathy. A VA medical opinion was obtained in September 2025, pursuant to a Board remand earlier that month. The examiner acknowledged that the medical records list diabetic retinopathy in 2022. Nevertheless, the examiner stated that it was not likely that the Veteran has diabetic retinopathy because the examinations were performed by resident physicians, not fully trained practitioners. Similarly, the findings of small, scattered microaneurysms and hemorrhages of the macula and diffuse scattered hemorrhages in the central retinal area were noted by a resident physician and not co-signed by a fully trained doctor until later. Upon review, the Board finds the VA opinion of little probative value as it lacks a reasoned medical explanation as required by Stefl v. Nicholson, 21 Vet. App. 120 (2007). Here, the examiner did not explain medically why the clinical findings did not support diabetic retinopathy and instead relied on the training status of the author of the report. VA law does not require that a diagnosis be authored by an attending physician to be competent medical evidence. See Cox v. Nicholson, 20 Vet. App. 563, 569 (2007) (physician's assistant was competent to perform examination). The Board finds that an additional remand to obtain yet another addendum opinion would likely serve no benefit to the Veteran. The Board declines to remand this case again and further delay disposition of this appeal. Furthermore, a review of the totality of the evidence reflects that the evidence is at least an approximate balance regarding whether the Veteran has a diagnosis of diabetic retinopathy. Accordingly, resolving reasonable doubt in favor of the Veteran, the Board finds that he has the diagnosed disorder. As the medical records relate the cause of this disorder to the Veteran's diabetes mellitus, and by definition, diabetic retinopathy is a complication of diabetes mellitus, the Board finds that all the elements of service connection on a secondary basis are met. Accordingly, affording the Veteran the benefit of all reasonable doubt, the Board finds that service connection is also warranted for the Veteran's bilateral diabetic retinopathy as secondary to his service-connected diabetes mellitus type 2. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310; Lynch, 21 F.4th at 776. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Horan, Deborah E. 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.