GLAUCOMA

Summary

The veteran, who served from June 1967 to October 1969, including service in the Republic of Vietnam, appeals the denial of service connection for glaucoma and chronic fatigue syndrome. Service connection was granted for glaucoma. The Board found the evidence in equipoise regarding the relationship between the veteran's service-connected Type II diabetes mellitus and glaucoma, resolving doubt in the veteran's favor to grant service connection. The Board noted that while medical literature suggests a link between diabetes and glaucoma, a direct causal relationship was not yet fully explained. The claim for chronic fatigue syndrome was remanded. The veteran has service-connected conditions including Type II diabetes mellitus, peripheral neuropathies, PTSD, bipolar I disorder, coronary artery disease, peripheral arterial disease, benign prostatic hyperplasia, irritable bowel syndrome, and erectile dysfunction. The Board found the VA examinations for chronic fatigue syndrome to be deficient, as they did not adequately address the relationship between the condition and the veteran's service-connected disabilities or presumed herbicide exposure. A new VA examination is ordered to determine the relationship between chronic fatigue syndrome, presumed herbicide exposure in Vietnam, and the veteran's service-connected conditions.

Rationale

Evidence in equipoise regarding relationship to Type II diabetes mellitus; Medical literature suggests link between diabetes and glaucoma; Doubt resolved in veteran's favor

Full Decision Text

Citation Nr: A26027431
Decision Date: 03/26/26	Archive Date: 03/26/26

DOCKET NO. 251114-595147
DATE: March 26, 2026

ORDER

Entitlement to service connection for glaucoma is granted.  

REMANDED

Entitlement to service connection for chronic fatigue syndrome is remanded.  

FINDINGS OF FACT

1. Service connection has been established for Type II diabetes mellitus; right upper extremity diabetic peripheral neuropathy; left upper extremity diabetic peripheral neuropathy; right lower extremity sciatic nerve diabetic peripheral neuropathy; left lower extremity sciatic nerve diabetic peripheral neuropathy; posttraumatic stress disorder (PTSD) and bipolar I disorder; coronary artery disease with percutaneous coronary intervention (PCI) residuals; right lower extremity peripheral arterial disease; left lower extremity peripheral arterial disease; benign prostatic hyperplasia; irritable bowel syndrome; and erectile dysfunction.  

2. Glaucoma has been shown to be related to the service-connected Type II diabetes mellitus.  

CONCLUSION OF LAW

The criteria for service connection for glaucoma have been met.  38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.310(a).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Veteran had active service from June 1967 to October 1969.  He served in the Republic of Vietnam.  

In March 2025, the Agency of Original Jurisdiction denied entitlement to service connection for a vision disability to include glaucoma and chronic fatigue.  In April 2025, the Veteran submitted a Decision Review Request: Higher-Level Review, VA Form 20-0996.  In July 2025, the Agency of Original Jurisdiction identified a duty to assist error as to the issues of entitlement to service connection for a vision disability to include glaucoma and chronic fatigue.  In September 2025, the Agency of Original Jurisdiction denied service connection for a vision disability to include glaucoma and chronic fatigue.  In November 2025, the Veteran submitted a Decision Review Request: Board Appeal (Notice of Disagreement), VA Form 10182, and elected the Direct Review docket.  Therefore, the Board of Veterans' Appeals (Board) may only consider the evidence of record at the time of the Agency of Original Jurisdiction decision on appeal which was subject to higher-level review.  38 C.F.R. § 20.301.  Any evidence submitted after the Agency of Original Jurisdiction decision on appeal cannot be considered by the Board.  38 C.F.R. §§ 20.300, 20.301, 20.801.  However, as the Board is remanding the claim for service connection for chronic fatigue, any evidence the Board could not consider will be considered by the Agency of Original Jurisdiction in the adjudication of that claim.  38 C.F.R. §3.103(c)(2)(ii).

In December 2025, the Board informed the Veteran that he had the opportunity to request a different review option by submitting a Decision Review Request: Board Appeal (Notice of Disagreement), VA Form 10182, within 60 days of the December 2025 Board correspondence.  In January 2026, the Veteran waived the opportunity to select a different Board review option.  38 C.F.R. § 20.1102; Williams vs. McDonough, 37 Vet. App. 305 (2024).

Service Connection for Glaucoma

The Veteran contends that service connection for a recurrent vision disability is warranted as the diagnosed glaucoma is related to the service-connected Type II diabetes mellitus.  

Service connection may be granted for disability which is proximately due to or the result of a service-connected disease or injury.  38 C.F.R. § 3.310(a).  Service connection shall be granted on a secondary basis under the provisions of 38 C.F.R. § 3.310(a) where it is demonstrated that a service-connected disorder has aggravated a nonservice connected disability.  Allen v. Brown, 7 Vet. App. 439 (1995).  Service connection has been established for Type II diabetes mellitus; right upper extremity diabetic peripheral neuropathy; left upper extremity diabetic peripheral neuropathy; right lower extremity sciatic nerve diabetic peripheral neuropathy; left lower extremity sciatic nerve diabetic peripheral neuropathy; PTSD and bipolar I disorder; coronary artery disease with PCI residuals; right lower extremity peripheral arterial disease; left lower extremity peripheral arterial disease; benign prostatic hyperplasia; irritable bowel syndrome; and erectile dysfunction.    

A November 2022 VA treatment record states that the Veteran was diagnosed
 where it is demonstrated that a service-connected disorder has aggravated a nonservice connected disability.  Allen v. Brown, 7 Vet. App. 439 (1995).  Service connection has been established for Type II diabetes mellitus; right upper extremity diabetic peripheral neuropathy; left upper extremity diabetic peripheral neuropathy; right lower extremity sciatic nerve diabetic peripheral neuropathy; left lower extremity sciatic nerve diabetic peripheral neuropathy; PTSD and bipolar I disorder; coronary artery disease with PCI residuals; right lower extremity peripheral arterial disease; left lower extremity peripheral arterial disease; benign prostatic hyperplasia; irritable bowel syndrome; and erectile dysfunction.    

A November 2022 VA treatment record states that the Veteran was diagnosed with glaucoma.  

The report of a February 2025 eye examination conducted for VA states that the Veteran was diagnosed with pseudophakia.  The examiner noted that the Veteran underwent cataract surgery in 2020.  The examiner concluded that the Veteran's "pseudophakia is due to natural age related progression."  

The report of an August 2025 eye examination conducted for VA states that the Veteran was diagnosed with bilateral glaucoma and pseudophakia.  The examiner commented that: "[t]he claimed condition is less likely than not (likelihood is less than approximately balanced or nearly equal) proximately due to or the result of diabetes mellitus;" "[while] there appears to be some connection between diabetes and glaucoma, that connection has not yet been fully explained;" "[m]edical literature does suggests that patients with diabetes are more likely to develop glaucoma, and vice versa (https://glaucoma.org/articles/diabetes-and-your-eyesight);" "[t]here is not enough evidence, however, to establish a causal relationship;" "[t]he exact etiology of primary open angle glaucoma is unknown, although a family history increases risk of developing disease;" and "[i]t is more likely that a combination of factors outside of the Veteran's diabetes contributed to the development of his glaucoma."

The evidence is in at least equipoise as to whether the diagnosed glaucoma is related to the service-connected Type II diabetes mellitus.  VA treatment records note that the Veteran has been diagnosed with glaucoma.  A VA examiner concluded that "there appears to be some connection between diabetes and glaucoma, that connection has not yet been fully explained" and "[m]edical literature does suggests that patients with diabetes are more likely to develop glaucoma."  Upon resolution of all reasonable doubt in the Veteran's favor, the Board concludes that service connection for glaucoma is warranted.  38 U.S.C. § 5107; 38 C.F.R. §§ 3.102. 3.310(a). 

REASONS FOR REMAND

Entitlement to service connection for chronic fatigue is remanded. 

The Veteran contends that service connection for chronic fatigue syndrome is warranted as the claimed disability is related to the service-connected Type II diabetes mellitus. 

VA's duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive.  McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121, 124 (1991).    

A disability examination and medical opinion will be requested for certain non-presumptive conditions involving a Toxic Exposure Risk Activity (TERA).  When a veteran submits a claim for compensation; has evidence of a disability; has evidence of participation in a TERA; and such evidence is not sufficient to establish service connection for the disability, then the veteran can claim participation in a TERA explicitly or implicitly through service in a location presumed associated with toxic exposure, or records showing participation in a TERA; or, if VA has conceded exposure in a prior claim, or the file has a claim attributable to toxic exposure.  Other ways to claim or establish participation in a TERA include, when a veteran's military occupational specialty is associated with toxic exposure; when medical records suggest exposure to a toxic substance, chemical, or airborne hazard such as Veterans Health Administration (VHA) exposure screening; or, with any other relevant evidence of record to include garrison exposures.  38 U.S.C. § 1168(a).

The service personnel records reflect that the Veteran served in the Republic of Vietnam.  Therefore, he is presumed to have been exposed to herbicide agents while performing his military duties.   As such, the provisions of 38 U.S.C. § 1168(a) requires that the Veteran be afforded a VA examination regarding whether a recurrent chronic fatigue disability is etiologically related to the Veteran's conceded participation in a TERA.

The report of a February 2025 chronic
 when medical records suggest exposure to a toxic substance, chemical, or airborne hazard such as Veterans Health Administration (VHA) exposure screening; or, with any other relevant evidence of record to include garrison exposures.  38 U.S.C. § 1168(a).

The service personnel records reflect that the Veteran served in the Republic of Vietnam.  Therefore, he is presumed to have been exposed to herbicide agents while performing his military duties.   As such, the provisions of 38 U.S.C. § 1168(a) requires that the Veteran be afforded a VA examination regarding whether a recurrent chronic fatigue disability is etiologically related to the Veteran's conceded participation in a TERA.

The report of a February 2025 chronic fatigue syndrome examination conducted for VA states that the Veteran was diagnosed with chronic fatigue syndrome.  The examiner concluded that the diagnosed chronic fatigue syndrome was less likely than not proximately due to or the result of the service-connected Type II diabetes mellitus.  The examiner commented that Type II diabetes mellitus "is not directly responsible for [chronic fatigue syndrome."  The examiner concluded that: "fatigue is a common distressing issue among individuals with diabetes;" "multiple risk factors can contribute to this fatigue;" and "there is no direct causal link between a diagnosis of chronic fatigue syndrome and Type II diabetes mellitus."  

The report of an August 2025 chronic fatigue syndrome examination conducted for VA states the Veteran was diagnosed with chronic fatigue syndrome.  The examiner concluded that the diagnosed chronic fatigue syndrome was less likely than not proximately due to or the result of the Type II diabetes mellitus.  The examiner commented that chronic fatigue syndrome is a diagnosis of exclusion, and that a "diagnosis of diabetes alone without detailed workup to rule others does not constitute this diagnosis, and thus a nexus is not established."  The VA examiner did not address the relationship between the diagnosed chronic fatigue syndrome and Type II diabetes mellitus, PTSD, and other service-connected disabilities and the diagnosed chronic fatigue syndrome; and did not address whether the disability is related to the Veteran's presumed herbicide agent exposure.  Considering such deficiencies, the Board finds the examination report is of limited probative value and further VA chronic fatigue evaluation is needed.  That is a pre-decisional error.  

The matter is REMANDED for the following action:

Schedule the Veteran for a VA chronic fatigue syndrome examination conducted by a medical doctor to determine the relationship between the diagnosed chronic fatigue syndrome, active service including the Veteran's presumed herbicide agent exposure, and the service connected disabilities.  The examiner must review the record and should note that review in the report.  A rationale for all opinions should be provided.  The examiner should:

(a)	Identify all recurrent fatigue disabilities found.  

(b)	Opine whether it is at least as likely as not (at least an approximate balance of positive and negative evidence) that the diagnosed chronic fatigue syndrome had its onset during service or is related to any incident of service, including the Veteran's presumed herbicide agent exposure in the Republic of Vietnam.

(c)	Opine whether it is at least as likely as not (at least an approximate balance of positive and negative evidence) that the diagnosed chronic fatigue syndrome is due to or the result of Type II diabetes mellitus, PTSD and bipolar disorder, and the other service-connected disabilities. 

(d)	Opine whether it is at least as likely as not (at least an approximate balance of positive and negative evidence) that any identified recurrent fatigue disability has been aggravated by Type II diabetes mellitus, PTSD and bipolar disorder, and the other service-connected disabilities.  

 

 

J. T. HUTCHESON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	K.R. Kardian, Counsel

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.