Citation Nr: 18142432 Decision Date: 10/15/18 Archive Date: 10/15/18 DOCKET NO. 14-23 319 DATE: October 15, 2018 ORDER Entitlement to service connection for bilateral posterior subcapsular cataracts is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran’s favor, his bilateral posterior subcapsular cataracts are at least as likely as not related to his in-service exposure to ionizing radiation. CONCLUSION OF LAW The criteria for service connection for bilateral posterior subcapsular cataracts have been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Air Force from March 1978 to June 1982. 1. Entitlement to service connection for bilateral posterior subcapsular cataracts The Veteran contends that his bilateral cataracts were caused by exposure to ionizing radiation during his military service. Therefore, he believes service connection is warranted. Initially, the Board notes that VA regulations allow for presumptive service connection for certain diseases for radiation-exposed veterans. 38 C.F.R. §§ 3.307(a), 3.309(d), 3.311. Cataracts are not included in the list of presumptive disabilities for radiation-exposed veterans. However, the Veteran may still establish entitlement to service connection through evidence showing direct causation. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131. Generally, the evidence 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. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (noting that nexus may be demonstrated by a showing of continuity of symptomatology where the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309(a)). With regard to a present disability, the Veteran has been diagnosed with cataracts in both eyes. See, e.g., VA treatment record, June 2011. The first element of Shedden/Caluza is met. With regard to an in-service event, the Veteran has reported exposure to radioactive ammunition for approximately 10 hours per week during service. An October 2012 memorandum from the Department of the Air Force indicates that the Veteran was exposed to 1.4 rem of ionizing radiation during service. See Air Force memo, October 2012. The second element of Caluza is also met. The remaining question is whether there is a medical nexus between the Veteran’s currently diagnosed bilateral cataracts and his in-service radiation exposure. The Board obtained an expert opinion from a Veterans Health Administration (VHA) ophthalmologist in September 2018. The ophthalmologist reviewed the Veteran’s entire claims file, including the information regarding his radiation exposure and the onset of his cataract symptoms. She concluded that his cataracts were likely due to his in-service radiation exposure. In providing this opinion, she cited a medical journal article regarding the risk of cataracts after exposure to low doses of ionizing radiation and noted that the type of cataracts that the Veteran has – posterior subcapsular cataracts – are more likely caused by ionizing radiation. She further explained that the Veteran would have been unusually young to be diagnosed with age-related cataracts. In light of this article and the Veteran’s age, she was able to link his cataracts to his in-service radiation exposure. The September 2018 VHA opinion is consistent with a May 2011 note from the Veteran’s treating ophthalmologist indicating that he had developed cataracts as a result of radiation exposure while working with radioactive ammunition in service. See VA treatment record, May 2011. The Board notes that a November 2017 memorandum from the Director of the Post-9/11 Environmental Health Service concludes that the Veteran’s cataracts were not due to in-service radiation exposure because his in-service exposure was too low. However, the Director failed to address the article cited by the VHA ophthalmologist that specifically discussed exposure to low doses of radiation exposure. Further, even if the Board were to accept the Director’s opinion as equally probative to the VHA ophthalmologist’s, the evidence would be in equipoise. As such, the Board finds that the evidence is, at a minimum, in equipoise regarding the question of whether the Veteran’s current bilateral posterior subcapsular cataracts are related to his military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. The benefit of the doubt will be conferred in the Veteran’s favor. The service-connection claim for bilateral posterior subcapsular cataracts is granted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Moore, Counsel